A Comparison of Stapled and Hand-Sewn Anastomoses in Crohn’s Disease

Kusunoki, Masato; Ikeuchi, Hiroki; Yanagi, Hidenori; Shoji, Yasutsugu; Yamamura, Takehira

doi:10.1159/000018677

Cited by 48 publications

(20 citation statements)

References 5 publications

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“…The groups were similar with the exception of mean follow-up (20 vs. 35 months) which may account for the difference in the symptomatic recurrence rates of 18% in the stapled and 48% in the sutured group. Two other studies have reported similar findings [8,9]. On the other hand, two other studies have found no difference in recurrence rates when the data were analyzed actuarially [10,11].…”

Section: Bowel Resectionmentioning

confidence: 64%

Surgery for Inflammatory Bowel Diseases

McLeod¹

2003

Dig Dis

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Surgery is required in many patients with inflammatory bowel disease at some point in their disease. In patients with ulcerative colitis, surgery is potentially curative whereas recurrence of Crohn’s disease following surgery is a common occurrence. As a result, the indications and surgical management of the two diseases may be quite different. Surgery is usually reserved for the management of complications or failure of medical treatment in Crohn’s disease. Resection of the diseased segment is the usual procedure performed. While surgery usually results in an improvement in quality of life, recurrence of disease occurs frequently with reported rates of 5–90% at 1 year, depending on the criteria used. To date, there have been no surgical maneuvers which have been shown to decrease the risk of recurrence. Over the past few decades, several advances have been made in the surgical management of Crohn’s disease: use of strictureplasty for extensive disease; use of laparoscopic techniques to perform surgery and the performance of the ileal pouch procedure in very selected patients. Significant advances in the surgical management of ulcerative colitis have been made in the past 50 years. Although there are several options available to patients, the preferred option now is the ileal pouch procedure. With technical modifications and with experience, this procedure can now be performed with a low complication rate, with good functional results and quality of life and excellent long-term outcome.

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Section: Bowel Resectionmentioning

confidence: 64%

Surgery for Inflammatory Bowel Diseases

McLeod¹

2003

Dig Dis

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“…The development of stapling devices has decreased the technical difficulty of colorectal surgery and the time required [14][15][16] for the construction of low colorectal anastomoses. These devices allow an anastomosis to be created consistently where one could not be constructed 17 with suturing techniques.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Unmeshed and 1:1 Meshed AlloDerm Bolsters for Stapled Rectal Anastomoses in a Porcine Model

Stewart

Perrone

Pierce

et al. 2008

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction: The major morbidity of colorectal anastomoses is leaks. The concept of staple-line reinforcement is a growing area of interest. In this study, we evaluated the feasibility and effect of utilizing AlloDerm to bolster end-to-end stapled rectal anastomoses in a porcine model. Methods: A total of 30 female 45-kg domestic pigs were studied, and each served as its own control by creating a bolstered and unbolstered anastomosis in each animal. All anastomoses were created with a 29-mm endto-end stapling device. Bolstered anastomoses were randomized to proximal and distal positions along the rectum, and each rectorectal anastomosis was separated by an average of 10 cm. In 20 pigs, an unmeshed bolster of a 0.5-0.7-mm thickness was used. The remaining 10 pigs had a 1:1 meshed bolster that was 0.34-0.51 mm thick. The animals were survived for 14 days. Barium enemas were then performed and the two anastomotic sites harvested, and each anastomosis underwent burst testing. The internal diameter of each anastomosis was measured and a biochemical analysis was performed for matrix metalloproteinase (MMP), elastin and collagen content. Results: The unmeshed bolstered anastomoses burst fewer times than the unbolstered anastomoses (P ϭ 0.004) and had higher burst pressures (P ϭ 0.023), though their anastomotic circumferences were smaller (P ϭ 0.007). Meshed bolsters offered no strength advantage to anastomoses and were significantly (P ϭ 0.009) smaller than unbolstered anastomoses in the same animal. No difference in elastin, collagen, or MMP content was observed between bolstered and unbolstered groups. No animals had clinical or radiographic leaks. Conclusions: The routine use of unmeshed and 1:1 meshed AlloDerm bolsters is safe and does not appear to inhibit healing in elective colorectal surgery on healthy subjects. AlloDerm may have a role as a tissue bolster in select patients who are more prone to develop anastomotic leaks.

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“…We previously demonstrated that the operation time for patients in the staple group tended to be shorter than that for patients in the hand-sewn group, and postoperative complications did not significantly differ between groups [7]. There was no statistically significant difference in the recurrence of Crohn’s disease at the anastomotic site at the median follow-up of 4.5 years (3 patients with recurrence in the staple group vs. 8 in the hand-sewn group).…”

Section: Discussionmentioning

confidence: 99%

“…However, these results suggest that stapling is not hazardous. In fact, it shortens the operating time, decreases blood loss, and improves the patient’s quality of life [7]. …”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Stapled and Hand-Sewn Anastomoses in Patients with Crohn’s Disease

Ikeuchi

Kusunoki

Yamamura³

2000

Dig Surg

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Aim: This study aimed at determining the reoperation rates of patients with anastomoses for Crohn’s disease. The outcome of patients undergoing stapled anastomoses was compared with that of patients having hand-sewn anastomoses. Methods: Sixty-three patients undergoing intestinal resection for Crohn’s disease at our institution from 1987 to 1996 were studied in a prospective, randomized trial. The group undergoing stapling comprised 30 patients and 37 anastomoses. The group with a hand-sewn anastomosis comprised 33 patients and 45 anastomoses. The median follow-up period was 87 (range 36–140) months. Results: There were no significant differences in operative indications or patients’ age and sex between the groups. There was a significant difference in cumulative recurrences between the groups (Cox-Mantel test: p = 0.022). Conclusion: A stapled anastomosis after resection for Crohn’s disease may delay reoperation in patients with symptomatic recurrence.

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A Comparison of Stapled and Hand-Sewn Anastomoses in Crohn’s Disease

Cited by 48 publications

References 5 publications

Surgery for Inflammatory Bowel Diseases

Surgery for Inflammatory Bowel Diseases

Evaluation of Unmeshed and 1:1 Meshed AlloDerm Bolsters for Stapled Rectal Anastomoses in a Porcine Model

Long-Term Results of Stapled and Hand-Sewn Anastomoses in Patients with Crohn’s Disease

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