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

Background. Disagreement continues among several studies as to the rel ative advantages and disadvantages of stapled versus sutured colorecta l anastomoses. Methods. One hundred and thirteen consecutive patients (48 men and 65 women, mean age: 67 +/- 12 years) were randomized to ei ther hand-sewn (n = 59) or stapled (n = 54) infraperitoneal colorectal anastomosis. Both groups had similar patient demographics except that fewer patients (4 versus 15) had chronic disease (p < 0.02) and were undergoing side-to-end (11 versus 39) and more patients were undergoin g end-to-end (37 versus 20) anastomosis in the stapled group (p < 0.00 1). Results. Overall mortality was 6% (7 of 113 patients, with no diff erence found between the two types of anastomosis. Fewer anastomotic l eaks occurred in the stapled group (11 versus 7), with an a posteriori gamma error of 11%, whereas the other early postoperative complicatio ns occurred with similar frequency in the two groups. Nine mishaps occ urred in the stapled group. Stapled anastomoses took less time (median , 42 versus 30 minutes) to perform (p < 0.02) At 8 months, two strictu res occurred in the hand-sewn group (n = 52) compared with eight stric tures in the stapled group (n = 50) (p < 0.007). Conclusions. It was n ot possible to prove that lower anastomosis can be achieved with the s tapling device. Routine or regular use of stapling instruments Sor inf raperitoneal colorectal anastomosis cannot be advocated because of hig her incidence of mishaps and strictures, even though the operation tak es less time to perform and anastomotic leakage occurs less often.