Analytical Cross-Sectional Study to Assess the Effectiveness of Bowel Anastamosis using Stapler v/s Handsewn Techniques in a Tertiary Hospital

Background: Intestinal anastomosis is a surgical procedure to establish communication between two formerly distant portions of the intestine. This procedure restores intestinal continuity after removal of a pathological condition affecting the bowel. Intestinal anastomosis is one of the most commonly performed surgical procedures in the elective setting when resections are carried out for benign or malignant lesions of the gastrointestinal tract. Proper surgical technique and adherence to fundamental principles is imperative to ensure successful outcome after intestinal anastomosis. Intestinal anastomosis can be performed by a hand-sewn technique using absorbable or non-absorbable sutures, mechanical stapling devices or biological glues. To establish the better method of anastomosis among stapler and handsewn technique. To compare the results obtained from these two techniques and to assess the bowel?s ability to regain the continuity after anastomosis using two different methods. Methods: Written informed consent will be obtained from the patients undergoing the procedure. The patients with laparotomy and bowel anastomoses using these two techniques are included in this study. During follow up, patients are divided into two groups. First group patients by staplers. Second group patients by hand sewn technique and the patients are followed. Observations are tabulated according to the predesigned proforma. Results: This randomized controlled trial compared the outcome of hand sewn anastomosis with stapled anastomosis in 40 patients who presented in Department of General Surgery at Government Kilpauk Medical College. The results were analyzed and compared with other studies published in literature. The results are same for both hands sewn and stapler anastomosis group in all 4 groups regarding appearance of bowel sounds, resumption of oral feeds and post-operative hospital stay. Regarding the total operation time it is shorter in stapler group of gastrojejunostomy, ileocolic and colorectal subgroups as compared to hand sewn technique. It is same for anastomosis inoesophogogastrostomy group. The results are the same as far as complications are concerned, that is 2 anastomotic leaks in each group of oesophagogastric anastomosis. (10% for each group). Regarding the mortality there are 3 deaths amounting to 7.5%. One death in colonic group which is due to unrelated cause.The other 2 in oesophoagogastric anastomosis, 1 in each of hands sewn and stapler anastomosis group. There are no other complications. With the added benefit of short operation time, stapled anastomosis scores over hands sewn anastomosis. Conclusion: By this study it is concluded that neither hand sewn nor stapler anastomosis is favored for GI anastomosis. Surgeons therefore select the technique of their choice depending on the availability of facilities. The stapler can be beneficial in the armamentarium of the operating theatre. One should not forget to master the art of conventional GI anastomosis technique.