Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy. A prospective, randomized study.
A prospective, randomized study of hand-sutured (group 1, n = 19) and double-stapled (group 2, n = 21) ileoanal anastomosis was carried out in 40 consecutive patients during restorative proctocolectomy to compare complications and functional outcome. Eight patients (42%) in group 1 and 12 (57%) in group 2 had one or more complications. Four patients in group 1 and five in group 2 developed pelvic sepsis. One stapled anastomosis had to be converted to a hand-sutured one because of severe anastomotic stricture. Four patients in group 1 and eight in group 2 had no nighttime evacuations 3 months after surgery and seven patients in group 1 and 11 in group 2 had no nighttime evacuations six months after surgery. Mucous leakage occurred in two vs five patients after 6 months in groups 1 and 2, respectively. The mean resting anal pressure decreased 30% in group 1 and 28% in group 2. In conclusion, double-stapled ileoanal anastomosis does not offer any functional or technical advantage over hand-sutured anastomosis, but it does leave some of the disease behind.
Department of Surgery, University Central Hospital, Helsinki, Finland.
P
P
Luukkonen
H
H
Järvinen
D011125:Adenomatous Polyposis Coli / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D013528:Surgical Staplers; D013536:Suture Techniques; D016896:Treatment Outcome