[Manual or mechanical right colon anastomosis?]

One hundred and forty patients were included in a prospective, randomized, multidepartmental study in order to compare four manual and on mechanical type of ileocolic anastomoses after right hemicolectomy for cancer. The study was designed as a pragmatic trial as defined by Schwartd. The main criterion of assessment was the anastomotic dehiscence judged with clinical criteria or a systematic follow-through with Gastrograffine on the tenth day postoperatively. All groups were similar except for a lower incidence of intraoperative septic factors for the group treated with mechanical anastomoses. The results show that the mechanical anastomosis produces fewer anastomotic dehiscences than all the other procedures except the terminolateral anastomosis with separate stitches using a slow-absorption suture material. Although it is about ten times as expensive as manual anastomosis, we suggest performing a mechanical ileocolic anastomosis after right hemicolectomy for cancer or, failing that, a manual terminolateral anastomosis with separate stitches.