CAN STAPLED ANASTOMOSIS IN VISCERAL SURGERY STILL BE JUSTIFIED - A PROSPECTIVE CONTROLLED RANDOMIZED STUDY OF THE COST-EFFECTIVENESS OF HAND-SEWN AND STAPLED ANASTOMOSES

Hospitals are facing increasing economic pressure. It therefore seems necessary to evaluate the efficiency and effectiveness of medical or s urgical interventions. In this study 324 anastomoses (167 stapled and 157 hand-sewn) were performed after randomization during 200 elective operations [20.5% gastrectomies, 14 % gastric resections (Billroth II) , 15 % Whipple's procedures, 4 % segmental colonic resections, 18 % ri ght-sided hemicolectomies, 4 % left-sided hemicolectomies, 22 % sigmoi d- or anterior rectal resections, 2.5 % total colectomies with pouch-a nal anastomoses] in 200 patients. Postoperative motility (time to full oral diet, time with naso-gastric tube) and hospitalization were comp arable in both groups. Anastomotic insufficiency was observed in 2.1 % of all patients, five after stapled and two after hand-sewn anastomos es. Hospital mortality was 1.5%. All stapled anastomoses were performe d significantly (P < 0.001) faster. However, the cost of material for these anastomoses was significantly (P < 0.001) higher, resulting in s ignificantly higher total costs for reconstruction. The time saving fo r the reconstruction did not influence the total operative time (excep t for stapled gastrectomy). Therefore, all operations with stapled rec onstruction were more expensive than those with sutured reconstruction . The difference was significant for the gastrectomy (P < 0.01), colon ic resection (P < 0.01) and sigmoid and rectal resection (P < 0.001) g roups. Stapled and sutured anastomoses are equally effective. Stapled anastomoses are not efficient, however, and should be reserved for ind ividual indications.