title: HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA Trial): results of a multicenter randomized trial (DRKS00000040).
abstract: OBJECTIVE
  The objective of the HASTA trial was to compare hand suture versus stapling loop ileostomy closure in a randomized controlled trial.
  
  
  BACKGROUND
  Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy after low anterior resection. The best surgical technique for closure of loop ileostomy has not been defined yet.
  
  
  METHODS
  HASTA trial is a multicenter pragmatic randomized controlled surgical trial with 2 parallel groups to compare hand suture versus stapling for closure of loop ileostomy. The primary endpoint was the rate of bowel obstruction within 30 days after ileostomy closure.
  
  
  RESULTS
  A total of 337 randomized patients undergoing closure of loop ileostomy after low anterior resection because of rectal cancer in 27 centers were included. The overall rate of postoperative ileus after ileostomy closure was 13.4%. Seventeen of 165 (10.3%) patients in the stapler group and 27 of 163 (16.6%) in the hand suture group developed bowel obstruction within 30 days postoperatively [odds ratio (OR) = 1.72; 95% confidence interval (CI): 0.89-3.31 = 0.10]. Duration of surgical intervention was significantly shorter in the stapler group (15 minutes; P < 0.001). Multivariable analysis of potential risk factors did not reveal any significant correlation with development of postoperative ileus. Rate of anastomotic leakage (stapler: 3.0%, hand suture: 1.8%, P = 0.48) did not differ significantly as well as all other secondary endpoints.
  
  
  CONCLUSIONS
  Hand-sewn anastomosis versus stapler ileo-ileostomy for ileostomy closure are equally effective in terms of postoperative bowel obstruction, with stapler anastomosis leading to a shorter operation time. Postoperative ileus after ileostomy reversal remains a relevant complication.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Löffler
authors.forename: Inga
authors.initials: I
authors.lastname: Rossion
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.forename: Markus K
authors.initials: MK
authors.lastname: Diener
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
authors.forename: Moritz
authors.initials: M
authors.lastname: von Frankenberg
authors.forename: Julius
authors.initials: J
authors.lastname: Pochhammer
authors.forename: Oliver
authors.initials: O
authors.lastname: Thomusch
authors.forename: Thomas
authors.initials: T
authors.lastname: Kijak
authors.forename: Thomas
authors.initials: T
authors.lastname: Simon
authors.forename: André L
authors.initials: AL
authors.lastname: Mihaljevic
authors.forename: Matthias
authors.initials: M
authors.lastname: Krüger
authors.forename: Erwin
authors.initials: E
authors.lastname: Stein
authors.forename: Gerald
authors.initials: G
authors.lastname: Prechtl
authors.forename: René
authors.initials: R
authors.lastname: Hodina
authors.forename: Walter
authors.initials: W
authors.lastname: Michal
authors.forename: Roland
authors.initials: R
authors.lastname: Strunk
authors.forename: Karl
authors.initials: K
authors.lastname: Henkel
authors.forename: Jörg
authors.initials: J
authors.lastname: Bunse
authors.forename: Gregor
authors.initials: G
authors.lastname: Jaschke
authors.forename: Dirk
authors.initials: D
authors.lastname: Politt
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Heistermann
authors.forename: Mathis
authors.initials: M
authors.lastname: Fußer
authors.forename: Claas
authors.initials: C
authors.lastname: Lange
authors.forename: Achim
authors.initials: A
authors.lastname: Stamm
authors.forename: Andreas
authors.initials: A
authors.lastname: Vosschulte
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.forename: Lars Ivo
authors.initials: LI
authors.lastname: Partecke
authors.forename: Emanuel
authors.initials: E
authors.lastname: Burdzik
authors.forename: Hubert M
authors.initials: HM
authors.lastname: Hug
authors.forename: Steffen P
authors.initials: SP
authors.lastname: Luntz
authors.forename: Meinhard
authors.initials: M
authors.lastname: Kieser
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007415:Intestinal Obstruction / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012307:Risk Factors; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome