Stapler versus handswen in small intestinal anastomosis

Mohamed Abdelhady Mohamed, Mohamed Leithy Ahmed, Mahmoud Gamal Eldin Hagag, Mohammed Nazeeh Shaker Nassar


Background: Intestinal anastomosis dates back to 1000, B.C but it accompanied with high rates of failure, sepsis, wound infection and mortality until the development of suture materials. Lembert described his seromuscular suture technique in 1826. Surgical Stapler was first introduced by Hultl in 1908. The development of modern devices over the past 30 years changes the surgical practice dramatically. The objective of present study is to compare the outcome between Stapler and handswen anastomosis in the small intestine.

Methods: This study is a randome controlled study carried on 40 patients divided into two equal groups, 20 patients were treated by handswen suture method (group A) and the other 20 patients operated by stapling technique (group B).

Results: In both elective and emergent cases as regard patient operative time, postoperative passing flatus, begin of oral intake, hospital stay duration and postoperative complications it was lower in Stapler (group B) comparing to handswen (group A) and P-value was statistically significant (P<0.05). In emergent cases postoperative leakage is equal in both handswen (group A) and Stapler (group B) and P-value was non-significant (P>0.05).

Conclusions: In both elective and emergent cases the duration of operation, postoperative passing flatus, return of bowel sound, hospitalization days and postoperative complications including (intraoperative bleeding, prolonged ileus >4 days, patient stenosis and wound infection) in Stapler anastomosis it was lower comparing to handswen anastomosis and P-value was statistically significant (P<0.05). No significant difference in postoperative leakage between handswen anastomosis and Stapler anastomosis in emergency cases (P>0.05).


Handswen, Small intestinal anastomosis, Staplers

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Jason PF, Cynthia WL, Mallory S. Stapler versus handswen in emergency general surgery. Acute Care Surg. 2013;74:1178-94.

Benjamin RP, Reducing gastrointestinal anastmotic rates. Open Acc Surg. 2016;9:5-14.

Vikram K, Kurt ER, Kalayarasan R, Mohta A, Pranavi AR. Intestinal anastomosis, practice, essentials, background, indication. Drugs and Diseases: Clinical Proce. 2018.

Kim IY, Kim BR, Kim YW, Applying reinforcing sutures to stapled colorectal anastomosis after low anterior resection for rectal cancer. Eur J Surg Oncol. 2015;41:808-9.

Whitelaw DE, Richard N, Darll MB. Kirks in surgery. Small bowel and operations for obesity. Churchill Liningstone. 2013;11:185-90.

Bradley C, Jeffery RP, Mark E. Atlas of Surgical Techniques for The Upper Gastrointestinal Tract and Small Bowel. Small bowel resection and anastomosis. Saunders Elsevier. 2010;23:253-254

Frances G. Bowel anastomosis; the theory, the practice and the evidence base. World J Gastrointestinal Surg. 2012;4(9):208-13.

Rushin BT, Sandeep S, Priyank A. A comparative study of hand suture verses stapler anastomosis gastrointestinal surgeries. Nat J Med Res. 2014;4(4):354-6.

Banurekha R, Sadasivam S, Sathyamoorthy K. Hand sewn versus stapler anastomosis in elective gastro intestinal surgeries. Int Surg J. 2017;4:2316-20.

Robert JF, David S, Scott HP, Prestone R. Stapled versus handswen a prospective emergency surgery study. J Trauma Med Res. 2017;82(3)435-43.