Elsevier

Surgery

Volume 118, Issue 3, September 1995, Pages 479-485
Surgery

Supraperitoneal colorectal anastomosis: Hand-sewn versus circular staples—a controlled clinical trial

https://doi.org/10.1016/S0039-6060(05)80362-9Get rights and content

Background Although used widely for supraperitoneal anastomoses, circular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied these anastomoses specifically, the only significant difference found was that there were more clinically obvious leakages with the circular stapled variety, but not in the overall clinical and roentgenologic leakage rates.

Methods. One hundred fifty-nine consecutive patients (88 men and 71 women, mean age 65.8±12.1years) were randomized to undergo hand-sewn (n=74) or circular stapled (n=85) supraperitoneal colorectal anastomosis after left colectomy.

Results. Patient demographics were similar in both groups. Overall mortality was 1.3% (2 of 159; one in each group). No statistically significant difference (NS) was found in the rate of early complications, including anastomotic leakage (4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, respectively). Mishaps (n=10) and hemorrhage (n=5) occurred in the stapled group only. Stapled anastomoses took an average of 8 minutes less to perform (p<0.001), but this time gain did not significantly influence the overall duration of operation (identical median times). The median duration of hospitalization was 13 and 14 days, respectively (NS). At 8 months there were 2 of 74 strictures in the hand-sewn group and 4 of 85 strictures in the stapled group (NS).

Conclusions. According to these results, there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal colorectal anastomosis.

References (33)

  • BrennanSS et al.

    Staplers or sutures for colonic anastomosis—a controlled clinical trial

    Br J Surg

    (1982)
  • CajozzoM et al.

    Advantages and disadvantages of mechanical vs manual anastomosis in colorectal surgery. A prospective study

    Acta Chir Scand

    (1990)
  • FriendPJ et al.

    Stapling or suturing for anastomoses of the left side of the large intestine

    Surg Gynecol Obstet

    (1990)
  • Suturing or stapling in gastrointestinal surgery: a prospective randomized study

    Br J Surg

    (1991)
  • OveryRD et al.

    Staples or sutures in the colon? A random controlled trial of three methods of colonic anastomosis

    Br J Surg

    (1980)
  • EverettWG et al.

    Comparison of stapling and hand-suture for left-sided large bowel anastomosis

    Br J Surg

    (1986)
  • Cited by (89)

    • A novel approach to lower rectal anastomosis: Technique innovation and the preliminary report of twenty cases

      2016, Journal of Coloproctology
      Citation Excerpt :

      Colorectal surgeries have drastically evolved during the past few decades. The emergence of Colo- and ileoanal stapled EEA techniques have propelled the development of modern very low rectal anastomosis and reduced the risk of leakage and other complications.7,8 For low anastomosis in general, a higher incidence of urgent defecation, fecal incontinence, evacuation disorders, coupled with frequent bowel movements are expected.9

    • Anastomotic technique-Does it make a difference?

      2014, Seminars in Colon and Rectal Surgery
    View all citing articles on Scopus
    *

    A.R.C. (Association de Recherche en Chirurgie), and A.U.R.C. (AssociationUniversitaire de Recherche en Chirurgie).

    View full text