Comparison of stapling and handsuture for left-sided large bowel anastomosis

Abstract

One hundred patients undergoing elective left-sided colonic or rectal resections were randomly allocated to have an anastomosis performed either with the EEA stapling gun or by hand suture using a single layer of interrupted sutures. In six patients the anastomosis could not be performed with the stapling gun. Clinical leakage occurred in two of the remaining 94 cases; both had hand-sutured anastomoses. Radiological leakage was demonstrated in 13 further cases (7 stapled, 6 sutured); there was no statistical difference in leakage rate with stapled and hand-sutured anastomoses.

Short‐term functional outcome following elective surgery for complicated sigmoid diverticular disease: sutured or stapled end‐to‐end anastomosis to the proximal rectum?

“…Anastomotic stenosis was significantly greater in this series using the stapled technique ( P =0.04), and stapled anastomosis was associated with poorer short‐term functional outcome. Similar to reports by others [2,3,8,11,12], the cost of anastomosis in this series was significantly greater than that of hand‐sewn anastomosis ( P < 0.0001). Although the inflammatory response has been shown to be less with stapled anastomosis [15–17], staples themselves may result in delayed mucosal healing [18] and stricture formation.…”

“…[12] reported differences of significance in both total leak rates (10% vs 36.2%, P < 0.001) and radiological leak rates (7% vs 24.1%, P < 0.05), for sutured vs stapled low colorectal anastomoses. Others [2,10,13,14] however, have found no significant difference in either clinical or radiological leakage rates. In the present study, routine post‐operative contrast imaging was not performed as we believe radiological leakage to be of little clinical relevance.…”

Short‐term functional outcome following elective surgery for complicated sigmoid diverticular disease: sutured or stapled end‐to‐end anastomosis to the proximal rectum?

“…Anastomotic stenosis was significantly greater in this series using the stapled technique ( P =0.04), and stapled anastomosis was associated with poorer short‐term functional outcome. Similar to reports by others [2,3,8,11,12], the cost of anastomosis in this series was significantly greater than that of hand‐sewn anastomosis ( P < 0.0001). Although the inflammatory response has been shown to be less with stapled anastomosis [15–17], staples themselves may result in delayed mucosal healing [18] and stricture formation.…”

“…[12] reported differences of significance in both total leak rates (10% vs 36.2%, P < 0.001) and radiological leak rates (7% vs 24.1%, P < 0.05), for sutured vs stapled low colorectal anastomoses. Others [2,10,13,14] however, have found no significant difference in either clinical or radiological leakage rates. In the present study, routine post‐operative contrast imaging was not performed as we believe radiological leakage to be of little clinical relevance.…”

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

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Influence of preoperative septic peritonitis and anastomotic technique on the dehiscence of enterectomy sites in dogs: A retrospective review of 210 anastomoses

“…Others have suggested that stapled anastomoses are preferred in human patients undergoing general elective surgery . A study by Everett et al in 1986 and by Choy et al in 2011 reported that stapled anastomoses performed by novice surgeons and stapled ileocolic anastomoses, respectively, were less likely to dehisce than their hand‐sewn counterparts . These recent human retrospective studies cannot be directly compared to ours for multiple reasons, including presence of septic peritonitis in our study.…”

Short‐term functional outcome following elective surgery for complicated sigmoid diverticular disease: sutured or stapled end‐to‐end anastomosis to the proximal rectum?

“…Anastomotic stenosis was significantly greater in this series using the stapled technique ( P =0.04), and stapled anastomosis was associated with poorer short‐term functional outcome. Similar to reports by others [2,3,8,11,12], the cost of anastomosis in this series was significantly greater than that of hand‐sewn anastomosis ( P < 0.0001). Although the inflammatory response has been shown to be less with stapled anastomosis [15–17], staples themselves may result in delayed mucosal healing [18] and stricture formation.…”

“…[12] reported differences of significance in both total leak rates (10% vs 36.2%, P < 0.001) and radiological leak rates (7% vs 24.1%, P < 0.05), for sutured vs stapled low colorectal anastomoses. Others [2,10,13,14] however, have found no significant difference in either clinical or radiological leakage rates. In the present study, routine post‐operative contrast imaging was not performed as we believe radiological leakage to be of little clinical relevance.…”

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

“……”

“……”

Influence of preoperative septic peritonitis and anastomotic technique on the dehiscence of enterectomy sites in dogs: A retrospective review of 210 anastomoses

“…Others have suggested that stapled anastomoses are preferred in human patients undergoing general elective surgery . A study by Everett et al in 1986 and by Choy et al in 2011 reported that stapled anastomoses performed by novice surgeons and stapled ileocolic anastomoses, respectively, were less likely to dehisce than their hand‐sewn counterparts . These recent human retrospective studies cannot be directly compared to ours for multiple reasons, including presence of septic peritonitis in our study.…”

Short‐term functional outcome following elective surgery for complicated sigmoid diverticular disease: sutured or stapled end‐to‐end anastomosis to the proximal rectum?

“…Anastomotic stenosis was significantly greater in this series using the stapled technique ( P =0.04), and stapled anastomosis was associated with poorer short‐term functional outcome. Similar to reports by others [2,3,8,11,12], the cost of anastomosis in this series was significantly greater than that of hand‐sewn anastomosis ( P < 0.0001). Although the inflammatory response has been shown to be less with stapled anastomosis [15–17], staples themselves may result in delayed mucosal healing [18] and stricture formation.…”

“…[12] reported differences of significance in both total leak rates (10% vs 36.2%, P < 0.001) and radiological leak rates (7% vs 24.1%, P < 0.05), for sutured vs stapled low colorectal anastomoses. Others [2,10,13,14] however, have found no significant difference in either clinical or radiological leakage rates. In the present study, routine post‐operative contrast imaging was not performed as we believe radiological leakage to be of little clinical relevance.…”

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

“……”

“……”

Influence of preoperative septic peritonitis and anastomotic technique on the dehiscence of enterectomy sites in dogs: A retrospective review of 210 anastomoses

“…Others have suggested that stapled anastomoses are preferred in human patients undergoing general elective surgery . A study by Everett et al in 1986 and by Choy et al in 2011 reported that stapled anastomoses performed by novice surgeons and stapled ileocolic anastomoses, respectively, were less likely to dehisce than their hand‐sewn counterparts . These recent human retrospective studies cannot be directly compared to ours for multiple reasons, including presence of septic peritonitis in our study.…”