Stapling devices: comparative study of stapled versus conventional hand sewn anastomosis in elective gastrointestinal surgery

Abstract

Background: Gastro intestinal anastomosis is a commonly performed surgical procedure to establish communication between two formerly distant portions of the bowel since the era of Sushruta. Various methods of intestinal anastomosis were followed. Stapling devices are now the newer alternative to conventional hand sewn method of anastomosis. It is stated that a key to a successful anastomosis is accurate anastomosis of two viable ends of the bowel without tension, with good vascularity. Because of the use of staplers technical failures is a rarity, anastomosis is more consistent, and can be used at difficult locations.Methods: A total of 68 cases which met the inclusion and exclusion criteria were included in this hospital based prospective comparative study. The study population included patients who underwent elective gastrointestinal surgeries. The subjects were allocated into two groups according to the type of anastomosis, hand sewn and stapler. Both hand sewn and stapled anastomosis were further divided into three sub-groups according to the anatomical site of anastomosis viz esophageal, gastrojejunal and colorectal. Outcome factors: anastomotic integrity, duration of operation, return of bowel activity, hospital stay.Results: A total of 68 patients with malignant or benign condition of bowel and oesophagus, requiring anastomosis were allocated in study group of GI staplers and control group of conventional hand sewn technique. Out of 68 cases there were 13 Esophageal anastomosis, 21 gastrojejunostomy and 34 colorectal anastomosis.Conclusions: In present study, we found that stapling technique can significantly reduce the time for anastomotic procedure, less tissue trauma due to less tissue handling, there is early restoration of gastrointestinal function, early resumption of oral feeding and reduced duration of hospital stay which helps ultimately in early return to routine work, importantly staplers can be used at places were hand sewn anastomosis is technically difficult. Technique related complications do not show significant differences which suggest that one can use staplers with same safety and accuracy as sutures.