title: Evaluation of stapled versus hand-sewn techniques for colo- rectal anastomosis after low anterior resection of mid-rectal carcinoma: a study on 50 patients.
abstract: OBJECTIVE
  To evaluate the outcome of stapled versus sutured colo-rectal anastomosis after low anterior resection of mid-rectal carcinoma.
  
  
  METHODS
  A prospective study of fifty patients who underwent colo-rectal anastomosis following low anterior resection (LAR) of T2 mid-rectal cancers at the Egyptian National Cancer Institute during the time period from June 2010 to June 2013 was conducted. Classification was into two groups; a stapled anastomosis group I (25 patients) and a hand-sewn anastomosis group II (25 patients). All operations are evaluated regarding intra-operative complications such as anastomotic line bleeding, visceral injuries or major blood loss. The anastomotic time and operative time are documented for each operation. All patients are evaluated post-operatively for anastomotic leakage (AL), wound infection and ileus.
  
  
  RESULTS
  The distance of the tumor from the anal verge was 9.6 ± 2.0 cm in group I and 9.9 ± 2.4 cm in group II. The mean operative time was 191.5 ± 16.2 min in the stapled group and 208 ± 18.6 min in the sutured group (p=0.002). The mean anastomotic times were 9.0 ± 1.9 min and 19.7 ± 12.2 min (p=0.001). Anastomotic leakage developed in three (12.0%) patients in the stapled group and in four (16.0%) patients in the sutured group (p=1.000). Post-operative ileus was observed in 3 patients in group I and one patient in group II. Wound infection developed in three (12.0%) patients in the stapled group and four (16.0%) patients in the sutured group (p=1.000).
  
  
  CONCLUSIONS
  Colo-rectal anastomosis after low anterior resection for mid rectal carcinoma can be conducted safely either by stapling or hand-sewn techniques; however the stapling technique showed shorter anastomotic and operative times with no significant advantages regarding intra- or post-operative complications or hospital stay.
authors.affiliation: Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt E-mail : drihab74@hotmail.com.
authors.forename: Ihab Samy
authors.initials: IS
authors.lastname: Fayek
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000601:surgery*; D002277:Carcinoma / Q000601:surgery*; D003106:Colon / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012307:Risk Factors