Critical evaluation of the anastomoses in large bowel surgery: experience gained in 533 cases

We critically examined the morbidity and mortality of manual and stapled colorectal anastomosis in a retrospective study of 533 patients who underwent colorectal resection for neoplastic and non-neoplastic disease. The clinically detected anastomotic dehiscence rate was 4.5%, and the mortality rate 1.8%. The extraperitoneal site of the anastomosis after rectal anterior resection with stapled anastomosis and surgery for cancer showed a statistically significant predisposition to anastomotic dehiscence. Age, emergency surgical intervention, curative versus palliative resection, the location of the anastomosed intestinal segments, type of anastomosis and presence of a protective colostomy did not appear to be statistically significant factors for anastomotic dehiscence. While the stapler may offer an advantage in the individual case, the low incidence of morbidity and mortality for manual anastomosis in this study reaffirms the soundness and importance of the manual colorectal anastomosis in the surgeon's technical armamentarium.