Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group.
OBJECTIVE
The authors compared both the initial and the long-term outcomes of patients undergoing stapled and sutured colorectal anastomoses.


BACKGROUND
Sutured and stapled large bowel anastomoses are perceived to be equally safe, but concern has been raised about increased rates of tumor recurrence with the use of stapling instruments.


METHODS
The outcome of patients with sutured and stapled colorectal anastomoses were compared in a prospective, multicenter, randomized study. Factors affecting long-term outcomes were assessed by both univariate and multivariate analysis.


RESULTS
Seven hundred thirty-two patients were recruited. There was a significant increase in radiologic leakage in the sutured group (14.4% vs. 5.2%, p < 0.05), but there was no difference in clinical anastomotic leak rates, morbidity, or postoperative mortality. Tumor recurrence and cancer-specific mortality were higher in the sutured patients (7.5% and 6.7%, respectively) and in patients with anastomotic leaks.


CONCLUSIONS
This study shows that suturing or stapling are equally safe in large bowel surgery. However, it also shows a long-term benefit of stapling in colorectal cancer patients.
Department of Surgical Gastroenterology, Gartnavel General Hospital, Glasgow, Scotland, United Kingdom.
J G
JG
Docherty
J R
JR
McGregor
A M
AM
Akyol
G D
GD
Murray
D J
DJ
Galloway
D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D017792:Surgical Stapling; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome