title: Stapled versus hand sewn anastomoses in patients with small bowel injury: a changing perspective.
abstract: BACKGROUND
  Recent studies indicate that trauma patients with hollow viscus injuries requiring anastomosis who are managed with stapling have a higher rate of complications than do those in whom a hand-sewn anastomosis is used. We undertook this study to determine whether this finding applied to patients 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 repair versus resection and stapled anastomosis demonstrated a nonsignificant decrease in overall complication rate (35% vs. 44%) and rate of intra-abdominal 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 hand-sewn primary repairs 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 complications (17% vs. 21%).
  
  
  CONCLUSIONS
  The rate of intra-abdominal complications did not differ significantly between patients requiring small bowel resection and reanastomosis managed by either a stapled or hand-sewn technique. In our experience, surgical stapling devices appear to be safe for use in repairing traumatic small bowel injury.
authors.affiliation: Department of Surgery, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis 55415, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Witzke
authors.forename: J J
authors.initials: JJ
authors.lastname: Kraatz
authors.forename: J M
authors.initials: JM
authors.lastname: Morken
authors.forename: A L
authors.initials: AL
authors.lastname: Ney
authors.forename: M A
authors.initials: MA
authors.lastname: West
authors.forename: J M
authors.initials: JM
authors.lastname: Van Camp
authors.forename: R T
authors.initials: RT
authors.lastname: Zera
authors.forename: J L
authors.initials: JL
authors.lastname: Rodriguez
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery; D000328:Adult; D003106:Colon / Q000293:injuries; D004766:Enterostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000293:injuries* / Q000601:surgery*; D008297:Male; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures