Impact of Surgical Experience on Burst Pressure of Hand-Sewn and Stapled Anastomoses

Both hand-sewn and stapled techniques for creating small bowel anastomoses are safe and have similar rates for leaks and stricture. Each technique comes with its own benefits and detriments, but a well-trained surgeon should be proficient in both anastomotic techniques. The understanding of tissue layers and meticulous technique needed to perform a proper hand-sewn anastomoses require greater skill and experience than a stapled anastomosis to achieve comparable results. This study is aimed to determine if there is a difference in anastomotic burst pressure between hand-sewn versus stapled anastomoses when they were performed by surgeons with differing years of experience.

Attending and resident surgeons with varying experience followed standardized instructions to create a hand-sewn and stapled anastomosis using segments of swine small intestine. Burst pressure was measured by inflating the intestine with air and using a manometer to record the pressure at which air leaked from the anastomosis.

Thirteen participants with 1-11 y of experience took part in this study. Burst pressure ranged between 4 and 76 mmHg for hand-sewn and 9 to 40 mmHg for stapled anastomoses. The mean burst pressures of stapled anastomoses were equal between less (mean = 29.0 mmHg, standard deviation [SD] = 8.54) and more (mean 29.0 mmHg, SD = 12.36) experienced surgeons. The difference in mean burst pressure of hand-sewn anastomoses for less experienced surgeons (mean = 34.6 mmHg, SD = 21.8) and more experienced surgeons (mean = 24.8 mmHg, SD = 5.26) was not statistically significant (P = 0.09). However, there was a significant difference between the SDs of the hand-sewn anastomoses of less and more experienced surgeons (P = 0.01, F = 17.1, F Crit = 9.2). There was no significant difference in our secondary outcome, mean burst pressure between hand-sewn 30.5 mmHg (SD = 18.4) and stapled anastomoses 29.0 mmHg (SD = 11.07) (P = 0.81).

While unable to detect differences regarding the impact of surgical experience on mean burst pressure of anastomoses, there is a greater range of burst pressures in the hand sewn group. In addition, we feel that the model of anastomotic testing we present represents the value, at all levels of training, of refining and practice advanced surgical technical skills on animal models.