Abstract
Background: Bowel anastomosis is successful when there is accurate union with no tension.Previous literature has compared between hand suturing and stapling devices in retrospective andprospective designs with varying outcomes. In this study a comparison between hand suturing andsurgical stapling in patients undergoing bowel surgery is done. Methods: A prospective study designover a period of 12 months was conducted in 40 patients undergoing elective resection andanastomosis. Different time parameters for anastomisis procedure, time taken for bowel sounds toreturn, resumption of oral feeds, postoperative hospital stay were collected. Follow up for 30 dayspost-operative was done. Results: In total forty patients were studied out of which twenty patientsunderwent hand sewn and twenty patients underwent stapler anastomosis. Main group analysis inmean time durations between hand sewn and stapler anastomosis were respectively; 35.25 minutesand 12 minutes for anastomosis, 3.4 days and 3.35 days for return of bowel sounds, 4.08 days and4 days for resumotion of oral feeds, 9.35 days and 8.50 days for post-operative hospital stay. A sub-group analysis was also done.Conclusion: Stapler anastomosis had shorter anastomosis time andtotal duration of operation compared to hand sewn anastomosis. However no difference was seen inreturn of bowel activity, resumption of oral feeds and duration of hospital stay.
Highlights
A successful anastomosis aims at accurate union of two viable bowel ends with complete avoidance of tension [1]
Hand suturing with improved suture materials remains the method of choice by most of the surgeons, stapling technique is emerged as an alternative method of anastomosis
Of the few prospective randomized trials comparing surgical stapling and manual suturing techniques, majority have focused on large bowel surgery and use of circular stapling instruments
Summary
A successful anastomosis aims at accurate union of two viable bowel ends with complete avoidance of tension [1]. The widespread application of stapling devices has helped revolutionize the technical aspects of surgery It was a prospective study.A total of 40 cases who meet the inclusion and exclusion criteria are included in this study. A meta-analysis comparing stapled and handsewn anastomosis in colorectal surgery included did not find any significant difference in the incidence of anastomotic leak between two techniques [2]. Main group analysis in mean time durations between hand sewn and stapler anastomosis were respectively; 35.25 minutes and 12 minutes for anastomosis, 3.4 days and 3.35 days for return of bowel sounds, 4.08 days and 4 days for resumotion of oral feeds, 9.35 days and 8.50 days for post-operative hospital stay. A subgroup analysis was done.Conclusion: Stapler anastomosis had shorter anastomosis time and total duration of operation compared to hand sewn anastomosis. No difference was seen in return of bowel activity, resumption of oral feeds and duration of hospital stay
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