Advantages of handsewn over stapled bowel anastomosis

Abstract

Bowel anastomoses are conventionally performed using a handsewn technique or a stapling device. Each has potential benefits and disadvantages. The most clinically significant complications of the bowel anastomosis are anastomotic leakage and stricture formation. The indices of healing and tissue cohesion were compared dynamically over time in 24 dogs randomized to undergo either a standard two-layer handsewn anastomosis or a stapled anastomosis with the Premium CEEA (United States Surgical Corporation, Norwalk, CT). Animals were sacrificed at 1, 4, 7, and 28 days postoperatively. Each anastomosis was evaluated for anastomotic index, burst pressure, collagen content, and histologic appearance. The anastomotic index was similar on postoperative day (POD) 1, 4, and 7; but on day 28 all handsewn anastomoses had larger diameters than the widest CEEA anastomosis. Burst pressure was higher in handsewn anastomoses at all intervals. Collagen content tended to be higher on POD 7 in the CEEA anastomoses. Histological evaluation showed more complete epithelialization and less inflammation in handsewn anastomoses on POD 28. The higher level of collagen in the CEEA anastomoses on POD 7 may be implicated in the tendency toward stricture formation found with this type of anastomosis. This study demonstrates that the greater speed and ease of the stapled anastomosis is offset by the greater strength, reduced tendency to stricture, and more complete healing of the handsewn anastomosis.

Systematic Review of the Technique of Colorectal Anastomosis

“…98,99 However, one of these had significantly more patients with corticosteroids in the stapled group, 99 while the other included 505 hand-sewn compared with 28 stapled colorectal anastomoses in 20 years. 98 Thirteen experimental studies 41,45,50,[90][91][92][93][94][95][96][97]105,106 included herein found results approximately similar to those in the clinical setting: no significant differences in AL, with equal or higher ABP in stapled colorectal anastomosis.…”

Early bursting strength of human colon anastomoses – an in vitro study comparing current anastomotic techniques

“…This was considered to be due to the fact that the surgeon used a standardized suture technique and the quality of the surgery he performed remained the same. Furthermore, hand-suture anastomoses show better tissue alignment than those made with automatic suturing devices which use standard diameters and compression levels [5]. The measured values for leaks and ruptures correspond with the results of available animal studies on dogs, pigs, and horses [2,4,7,8].…”

Single-layer continuous suture contributes to the reduction of surgical complications in digestive tract anastomosis involving special anatomical locations

“…However, improper handling of the stapler may lead to a partial tear of the anastomosis and leakage (17,18), whereas irregular suturing of the mucosa may lead to hyperplasia, granulation tissue and scar formation, which may cause a stricture (19,20). Furthermore, there was no reported difference in the morbidity and mortality rates between the hand-sewn and stapled techniques (21,22). Additionally, stapling has been criticized as it confers an increase in the overall expediture and, Single-layer continuous suture contributes to the reduction of surgical complications in digestive tract anastomosis involving special anatomical locations in certain cases, such as preoperative obstruction of the digestive tract, mucosal edema, increased thickness of the muscle layer and healing dysfunction, the use of staplers is restricted.…”