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Stapling Common Enterotomy Does Not Increase Leak Rates in Stapled Anastomoses.

Reid Bartholomew¹, Christopher M Zumwalt¹, Kristen R Reede¹

¹School of Medicine and Health Sciences, University of North Dakota, Fargo, ND, USA.

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|November 7, 2022

Summary

Closing common enterotomies with stapled techniques (SS) is as safe as handsewn methods (SH) regarding leak rates. The stapled-stapled approach offers a faster operative time, making it a potentially preferred option, especially in emergent situations.

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Area of Science:

Surgical techniques
Gastrointestinal surgery
Anastomotic integrity

Background:

Bowel anastomosis methods like stapled and handsewn are well-researched.
No prior studies directly compared handsewn versus stapled techniques for common enterotomy closure.
Concerns exist regarding higher leak rates with stapled closure due to crossing staple lines.

Purpose of the Study:

To compare the anastomotic leak rates between stapled-stapled (SS) and stapled-handsewn (SH) techniques for closing common enterotomies.
To evaluate the impact of closure technique on operative time and mortality.
To assess leak rates in emergent versus elective settings and within specific anastomosis types.

Main Methods:

Retrospective study of 758 patients undergoing stapled side-to-side anastomoses (2016-2020).
Patients divided into Stapled-Stapled (SS) and Stapled-Handsewn (SH) cohorts based on enterotomy closure.
Univariate and multivariate analyses used to compare leak rates, operative times, and mortality.

Main Results:

Overall and enteroenteric anastomotic leak rates were similar between SS and SH cohorts (P = .23 and P = .52, respectively).
The SS technique was associated with significantly shorter operative times (16.3 minutes shorter on average, P = .049).
No significant difference in mortality was observed between the two groups.

Conclusions:

Stapled-stapled and stapled-handsewn techniques yield comparable anastomotic leak rates.
The stapled-stapled technique offers a significant operative time advantage.
The stapled-stapled method is an acceptable alternative for common enterotomy closure, potentially preferred in emergent scenarios.