Stapled versus hand sewn anastomoses in patients with small bowel injury: A changing perspective

Introduction: Recent studies indicate that trauma patients with hollow visc us injuries requiring anastomosis who are managed with stapling have a high er rate of complications than do those in whom a hand-sewn anastomosis is u sed. We undertook this study to determine whether this finding applied to p atients with small bowel trauma at our institution. Methods: Records of patients with small bowel injuries were retrospectively reviewed. Demographics, severity of injury, injury management, and outcome data were collected. Results: Patients who had their small bowel injuries managed by hand-sewn r epair versus resection and stapled anastomosis demonstrated a nonsignifican t decrease in overall complication rate (35% vs. 44%) and rate of intra-abd ominal complication (10% vs. 18%). Yet the rate of intra-abdominal abscess formation was significantly lower with hand-sewn repair than with resection and stapled anastomosis (4% vs. 13%). However, when handsewn primary repai rs were excluded from the analysis and injuries that required resection and either stapled or hand-sewn anastomosis were compared, there was a similar overall complication rate (41% vs. 41%) and rate of intra-abdominal compli cations (17% vs. 21%). Conclusion: The rate of intra-abdominal complications did not differ signif icantly between patients requiring small bowel resection and reanastomosis managed by either a stapled or hand-sewn technique. In our experience, surg ical stapling devices appear to be safe for use in repairing traumatic smal l bowel injury.