Vol. 8, Issue 1, Part B (2024)

Background: Intestinal anastomosis is one of the most commonly performed surgical procedures for benign or malignant gastrointestinal conditions. The choice for anastomosis between a stapling device and a hand-sewn approach relies on the surgeon’s preference and also their level of surgical experience. Failure of intestinal anastomosis leads to anastomotic leakage; regarded one of the most commonly feared complication in surgical practice & is more serious and life threatening for malignant cases. This study was conducted with the objective of comparing the outcomes of stapling device and hand-sewn anastomosis of the gastrointestinal tract. 

Aims: To assess and compare the clinical outcome of the patient in any elective gastrointestinal surgery using a stapler device vs. the hand-sewn method of anastomoses. 

Methods: This prospective comparative study was conducted for 12 months at the Department of Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka. 50 subjects underwent elective surgery, with one group (N=25) undergoing stapling and the other group (N=25) undergoing hand-sewn anastomosis. 

Results: The mean age was 44.08±11.81 yrs. and 38.04±15.55 yrs. in the stapled group and hand-sewn group, respectively. The mean duration of surgery was 149.4±44.1 minutes in the stapled group and 183.6±60.1 minutes in the hand sewn group. Mean duration of surgery was significantly lower in the stapled group compared to the hand sewn group (P=0.026). Three (12.0%) patients had an anastomotic leak in the stapled group and two (8.0%) individuals in the hand-sewn anastomosis. No significant difference in postoperative leakage between the two groups (P=0.635). The postoperative complications—fever was significantly higher in the hand-sewn group compared to the stapler anastomosis group (p<0.05). The mean VAS score for pain showed a significant difference on day 3 and day 5. The mean hospital stay was 13.72±2.54 days in the stapler group and 15.76±1.98 days in the hand-sewn group. Mean hospital stay was significantly reduced in the stapler group compared to the hand sewn group (P=0.003). The mean drain indwelling time was 8.64±1.04 days in the stapler group and 8.04±1.34 days in the hand-sewn group, which was not statistically significant between groups (P=0.083). 

Conclusion: Stapling technique appears to be safer and superior to hand-sewing technique when operating time, hospital stay and fever are taken into account. There is no significant difference in anastomotic leak cases between the two techniques. Stapler anastomosis is a new surgical innovation that can be performed successfully and safely.