Staplers, two- and one-layer manual suturing in gastrointestinal surgery--a retrospective study of 553 patients

The case histories of all patients with gastrointestinal suturing in a six-year period were studied retrospectively. Anastomoses of the oesophagus, left colon and rectum were always checked radiologically 7-14 days after operation. Suture-line dehiscence, bleeding and stricture formation were seen in 18 cases (= 8.9%) out of 202 patients with stapled suturing, 15 cases (= 7.8%) out of 192 patients with two-layer manual suturing, and 4 cases (= 2.5%) out of 159 patients with one-layer seromuscular manual suturing. After excluding the patients with a pyloroplasty, the adverse factors were comparable in these groups of patients. The suture-line complication rate after one-layer manual suturing (2.5%) proved to be significantly lower than with stapled suturing (9.6%). Reduction in operating time by using the staplers proved to be minimal. The use of staplers is expensive and is not often indicated.