Citation Information :
Mitra AS, Chandak U, Kulkarni KK, Nagdive N, Saoji R, Tiwari C. Stapled vs Conventional Hand-sewn Gastrointestinal Anastomosis during Infancy: A Prospective Comparative Study from Central India. Euroasian J Hepatogastroenterol 2020; 10 (1):11-15.
Background: The creation of a joint between two bowel ends in newborns and infants is one of the core surgical procedures in pediatric surgery. For a proper and perfect gastrointestinal (GI) anastomosis, the factors to be considered are intraoperative duration, restoration of normal GI function, effective hemostasis, reduction of tissue damage, and prevention of postoperative mortality and morbidity. The safety and efficacy of stapled GI tract anastomosis in adults have been extensively documented; however, available literature on the same is limited for infants. Materials and methods: Fifty-six patients were divided into two groups—stapled group and hand-sewn group. Patients operated on both emergency and elective basis were included in the study. Hand-sewn anastomosis was done by either end-to-end single-layer or double-layer anastomosis. Suture material used for the anastomosis was Vicryl 3-0 or Vicryl 4-0. Stapled anastomosis was done by 55 mm linear cutting GI stapler with side-to-side anastomosis. Results: The present study included a total of 56 patients; there were 28 neonates and 28 infants; 37 of them were males. The most common clinical presentations were vomiting, abdominal distention, refusal to feed, and lethargy. The intraoperative duration in stapled GI anastomosis was less when compared to hand-sewn anastomosis, so was the return of bowel activity and consequently early initiation of feeds and shorter hospital stay. Conclusion: The present study favors stapled over hand-sewn GI anastomosis in infancy in view of decreased intraoperative duration, reduced blood loss, early return of peristalsis, early initiation of feeds, and shorter duration of hospital stay. However, a small number of patients and lack of matching are the shortcomings of this study.
Kozlov Y, Novogilov V, Podkamenev A, et al. Stapled bowel anastomoses in newborn surgery. Eur J Pediatr Surg 2013;23(1):63–66. DOI: 10.1055/s-0032-1326952.
Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled vs handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2012;15(2):CD003144.
Damesha N, Lubana P, Jain D, et al. A comparative study of sSutured and stapled anastomosis in gastrointestinal operations. Int J Surg 2007;15(2).
Shelygin YA, Chernyshov SV, Rybakov EG. Stapled ileostomy closure results in reduction of postoperative morbidity. Tech Coloproctol 2010;14(1):19–23. DOI: 10.1007/s10151-009-0550-y.
Steichen FM. The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses. Surgery 1968;64(5):948–953.
Steichen FM, Ravitch MM. Mechanical sutures in surgery. Br J Surg 1993;60(3):191–197. DOI: 10.1002/bjs.1800600307.
Steichen FM, Ravitch MM. Stapling in surgery. Chicago, IL: Year Book Medical; 1984. DOI: 10.1097/00000658-198408000-00017.
Talbert JL, Seashore SH, Ravitch MM. Evaluation of modified Duhamel operation for correction of Hirschsprung's disease. Ann Surg 1974;179(5):671–675. DOI: 10.1097/00000658-197405000-00021.
Martin LW, Altemeier WA. Clinical experience with a new operation (modified Duhamel procedure) for Hirschsprung's disease. Ann Surg 1962;156(4):678–681. DOI: 10.1097/00000658-196210000-00014.
Powell RW. Stapled intestinal anastomosis in neonates and infants: use of the endoscopic intestinal stapler. J Pediatr Surg 1995;30(2):195–197. DOI: 10.1016/0022-3468(95)90559-6.
Mortensen NJ, Ashraf S. Intestinal Anastomosis In Section 5 Gastrointestinal Tract and Abdomen 2008.
Lim CB, Goldin RD, Darzi A, et al. Characterization of materials eliciting foreign body reaction in stapled human gastrointestinal anastomoses. Br J Surg 2008;95(8):1044–1050. DOI: 10.1002/bjs.6071.
Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg 2004;14(10):1290–1298. DOI: 10.1381/0960892042583888.
Ho YH, Ashour MAT. Techniques for colorectal anastomosis. World J Gastroenterol 2010;16(13):1610–1621. DOI: 10.3748/wjg.v16.i13.1610.
Choy PY, Bissett IP, Docherty JG, et al. Stapled vs handsewn methods for ileocolic anastomosis. Cochrane Database Syst Rev 2011;7(9):CD004320.
MacRae HM, McLeod RS. Handsewn vs stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 1998;41(2):180–189. DOI: 10.1007/BF02238246.
Mitchell IC, Barber R, Fischer AC, et al. Experience performing 64 consecutive stapled intestinal anastomoses in small children and infants. J Pediatr Surg 2011;46(1):128–130. DOI: 10.1016/j.jpedsurg.2010.09.076.
Hintz GC, Alshehri A, Bell CM, et al. Stapled vs hand-sewn pediatric intestinal anastomoses: a retrospective cohort study. J Pediatr Surg 2018;53(5):959–963. DOI: 10.1016/j.jpedsurg.2018.02.021. Epub 2018 Feb 8.
Sato K, Uchida H, Tanaka Y, et al. Stapled intestinal anastomosis is a simple and reliable method for management of intestinal caliber discrepancy in children. Pediatr Surg Int 2012;28(9):893–898. DOI: 10.1007/s00383-012-3146-y. PMID: 22864546; PMCID: PMC3433672.