Comparison of Stapled vs. Hand-Sewn Anastomosis: A Prospective Randomized Controlled Trial
Optimizing Anastomosis in Colorectal Surgery
Keywords:
Colorectal surgery, Hand-sewn anastomosis, Randomized controlled trial, Stapled anastomosis, Surgical outcomesAbstract
Background: Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality worldwide. For patients undergoing colorectal surgery, anastomotic methods are essential. Although the data for comparable findings between the two techniques is consistent for different outcomes, they will likely be very valuable in their application. Thus, the study aimed to compare the clinical disparities between hand-sewn and stapled anastomosis in colorectal surgery.
Methods: This single-blinded randomized trial was conducted from July 2023 to September 2024 at Allama Iqbal Teaching Hospital, Dera Ghazi Khan, Punjab, Pakistan. One hundred fourteen patients undergoing elective colorectal surgery were randomly assigned to Group-A, who hand-sewn anastomosis, and Group-B, who received stapled anastomosis using a computer-generated random number sequence. Outcomes included post-operative time, surgical site infection and length of hospital stay. Data was analyzed using intention-to-treat analysis, and outcomes were compared using the chi-square test.
Results: Mean operating time was significantly more excellent in the Group-A (96.0 ± 9.2 minutes) than in the Group-B (82.5±8.5 minutes, p<0.001). The duration of hospital stay was significantly low in group B, who received stapler anastomosis, compared to Group-A, who received hand-sewn anastomosis (12.12±1.21 vs 14.01±1.32, p<0.01), respectively. Early surgical complications, including hematoma and wound infection, were rare.
Conclusion: Stapled and hand-sewn anastomoses demonstrated comparable rates of anastomotic leaks and surgical site infections. However, stapled anastomosis was associated with a reduced operative time. Both methods are considered adequate in colorectal surgery, with the choice often influenced by the surgeon’s preference and specific patient-related factors.
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