STAPLED VERSUS HANDSEWN INTESTINAL ANASTOMOSIS IN EMERGENCY SURGERY

Abstract

Introduction The major problem following bowel anastomoses is the anastomotic failure leading to leakage peritonitis, fistula, abscess, sepsis, necrosis, stricture etc. adding to the morbidity and mortality. (e.g., 22% mortality in patients with a leak vs. 7.2% mortality in those without leak).The present study compares the complication rates of sutured and stapled anastomotic techniques in an emergency setting of a tertiary care institute in Kerala. Methodology The study evaluates the complications (leak /intra-abdominal abscess) of both stapled and hand-sewn techniques of intestinal anastomosis in emergency setting. The study is conducted in a tertiary care centre in Kerala and the data is collected from the medical records and emergency register. A total of 112 cases that meet the inclusion and exclusion criteria are included during the period from 2017 to 2021 Results Among the 61 patients who had undergone hand sewn anastomosis 7 (11.5%) had anastomotic leak and 54 (88.5%) patients had no leak. Among the 51 patients underwent stapled anastomosis, 6 (11.8%) had anastomotic leak and 45 (88.2%) patients developed no leak. This data is statistically analyzed using Chi Squared test and found that there is no significant difference between the occurrence of anastomotic leak between the two study groups irrespective of whether the anastomosis is hand sewn or stapled. The average time taken for surgery in the hand sewn group is about 192.1 minutes and in stapled group is 162.5 minutes. This difference in the average duration of surgery is analyzed statistically and it showed that the difference in of the duration of surgery is statistically significant. Conclusion There is no significant difference between the complication rates of both type of anastomosis is identified in the emergency setting. But there is a clear advantage of less operating time for stapled anastomosis.