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Stapled vs Conventional Hand-sewn Gastrointestinal Anastomosis during Infancy: A Prospective Comparative Study from
Arti S Mitra1, Unmed Chandak1, Kaushal K Kulkarni1
1Department of General Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India.
Insights
Stapled gastrointestinal (GI) anastomosis in infants offers advantages over hand-sewn methods, including shorter surgery times and quicker recovery. This comparative study highlights stapling as a potentially superior technique for pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Innovation
Background:
- Gastrointestinal (GI) anastomosis is a critical procedure in pediatric surgery for newborns and infants.
- Optimal GI anastomosis requires consideration of operative time, functional recovery, hemostasis, tissue damage, and patient outcomes.
- While stapled anastomosis is well-documented in adults, evidence in infants is limited.
Purpose of the Study:
- To compare the efficacy and outcomes of stapled versus hand-sewn gastrointestinal anastomosis in infants.
- To evaluate key surgical parameters including operative duration, recovery, and hospital stay.
Main Methods:
- A prospective comparative study involving 56 infant patients, divided into stapled and hand-sewn anastomosis groups.
- Hand-sewn anastomosis utilized single-layer or double-layer techniques with Vicryl 3-0 or 4-0 sutures.
- Stapled anastomosis was performed using a 55 mm linear cutting GI stapler for side-to-side anastomosis.
Main Results:
- The study included 56 patients (28 neonates, 28 infants; 37 males) presenting with conditions like vomiting and abdominal distention.
- Stapled GI anastomosis demonstrated a shorter intraoperative duration compared to hand-sewn techniques.
- Patients undergoing stapled anastomosis experienced earlier return of bowel activity, earlier feeding initiation, and shorter hospital stays.
Conclusions:
- Stapled GI anastomosis is favored over hand-sewn techniques in infants due to reduced operative time, blood loss, and improved recovery metrics.
- Benefits include earlier peristalsis, earlier feeding, and shorter hospital stays.
- Limitations include a small patient cohort and lack of matching between groups.
Background:
The creation of a joint between two bowel ends in newborns and infants is one of the core surgical procedures in pediatric surgery. For a proper and perfect gastrointestinal (GI) anastomosis, the factors to be considered are intraoperative duration, restoration of normal GI function, effective hemostasis, reduction of tissue damage, and prevention of postoperative mortality and morbidity. The safety and efficacy of stapled GI tract anastomosis in adults have been extensively documented; however, available literature on the same is limited for infants.
Materials And Methods:
Fifty-six patients were divided into two groups-stapled group and hand-sewn group. Patients operated on both emergency and elective basis were included in the study. Hand-sewn anastomosis was done by either end-to-end single-layer or double-layer anastomosis. Suture material used for the anastomosis was Vicryl 3-0 or Vicryl 4-0. Stapled anastomosis was done by 55 mm linear cutting GI stapler with side-to-side anastomosis.
Results:
The present study included a total of 56 patients; there were 28 neonates and 28 infants; 37 of them were males. The most common clinical presentations were vomiting, abdominal distention, refusal to feed, and lethargy. The intraoperative duration in stapled GI anastomosis was less when compared to hand-sewn anastomosis, so was the return of bowel activity and consequently early initiation of feeds and shorter hospital stay.
Conclusion:
The present study favors stapled over hand-sewn GI anastomosis in infancy in view of decreased intraoperative duration, reduced blood loss, early return of peristalsis, early initiation of feeds, and shorter duration of hospital stay. However, a small number of patients and lack of matching are the shortcomings of this study.
How To Cite This Article:
Mitra AS, Chandak U, Kulkarni KK, et al. Stapled vs Conventional Hand-sewn Gastrointestinal Anastomosis during Infancy: A Prospective Comparative Study from Central India. Euroasian J Hepato-Gastroenterol 2020;10(1):11-15.
