SUPRAPERITONEAL COLORECTAL ANASTOMOSIS - HAND-SEWN VERSUS CIRCULAR STAPLES - A CONTROLLED CLINICAL-TRIAL

Background. Although used widely for supraperitoneal anastomoses, circ ular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied thes e anastomoses specifically, the only signiificant difference found was that there were more clinically obvious leakages with the circular st apled variety, but not in the overall clinical and roentgenologic leak age rates. Methods. One hundred fifty-nine consecutive patients (88 me n and 71 women, mean age 65.8 +/- 12.1 years) were randomizes to under go hand-sewn (n = 74) or circular stapled (n = 85) supraperitoneal col orectal anastomosis after left colectomy. Results. Patient demographic s were similar in both groups. Overall mortality was 1.3% (2 of 159 on e in each group). No statistically significant difference (NS) was fou nd in the rate of early complications, including anastomotic leakage ( 4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, resp ectively). Mishaps (n = 10) and hemorrhage (n = 5) occurred in the sta pled group only. Stapled anastomoses took an average of 8 minutes less to perform (p < 0.001), but this time gain did not significantly infl uence the overall duration of operation (identical median times). The median duration of hospitalization was 13 and 14 days, respectively (N S). At 8 months there were 2 of 74 strictures in the hand-sewn group a nd 4 of 85 strictures in the stapled group (NS). Conclusions. Accordin g to these results, there seems to be no advantage of routine or regul ar use of stapling instruments for supraperitoneal colerectal anastomo sis.