Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study.
BACKGROUND
Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma.


METHODS
This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs.


RESULTS
Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8%) the anastomosis was performed with handsewing and in the remaining 79 (38.2%) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7% (26.6% in the stapled group and 20.3% in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3% in the stapled group and 7.8% in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95% CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95% CI, 0.46-2.11, p = 0.99).


CONCLUSIONS
The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.
Demetriades
Demetrios
D
Los Angeles County and University of Southern California Trauma Center, Los Angeles, California, USA. demetria@hsc.usc.edu
Murray
James A
JA
Chan
Linda S
LS
Ordoñez
C
C
Bowley
D
D
Nagy
Kimberly K
KK
Cornwell
Edward E
EE
Velmahos
George C
GC
Muñoz
N
N
Hatzitheofilou
C
C
Schwab
C William
CW
Rodriguez
Aurelio
A
Cornejo
C
C
Davis
Kimberly A
KA
Namias
Nicholas
N
Wisner
David H
DH
Ivatury
Rao R
RR
Moore
Ernest E
EE
Acosta
Jose A
JA
Maull
Kimball I
KI
Thomason
Michael H
MH
Spain
David A
DA
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000009:adverse effects*; D003106:Colon / Q000293:injuries* / Q000601:surgery*; D003108:Colonic Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects*; D013536:Suture Techniques / Q000009:adverse effects*; D014950:Wounds, Penetrating / Q000601:surgery*