[The devil's advocate--commentary on sutures]

The decision between hand suture or stapler was tested for the large bowel in randomized trials whereas retrospectively only in the upper gastrointestinal and respiratory tract. No clear difference was seen concerning patient's security and cost-time consumption. The stapler is more comfortable but the handsuture technique is still recommended. By the stapler anatomically very difficult anastomoses can be performed. Whether this is an advantage for the patient has to be tested because the technical progress may decrease physical function (incontinence!) and quality of life. In summary, the stapler, if applied critically, seems to be useful.