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Complications after J-pouch ileoanal anastomosis: stapled compared with handsewn anastomosis
A Wettergren1, H J Gyrtrup, E Grosmann
1Department of Gastrointestinal Surgery C, Rigshospitalet, University of Copenhagen, Denmark.
Objective:
To compare the morbidity after stapled compared with handsewn J-pouch ileoanal anastomoses.
Design:
Retrospective study.
Setting:
University Hospital, Copenhagen, Denmark.
Subjects:
144 consecutive patients who underwent either handsewn or stapled J-pouch ileoanal anastomosis between November 1983 and December 1991.
Main Outcome Measures:
Length of operation; operative blood loss; incidence of anastomotic breakdown, fistula and stenosis; and number of pouches that were excised as a result of complications.
Results:
Ninety-six patients had handsewn, and 48 patients had stapled, anastomoses. There were no differences between the groups except in the length of operation (median (range) 270 (155-420) in the handsewn group compared with 197 (135-300) in the stapled group, p < 0.001), and the incidence of later stenosis of the anastomosis (22/96, 23%, compared with 3/48, 6%, p = 0.02). Patients who developed anastomotic breakdown lost significantly more blood during operation (median 2300 ml, range 1100-7500, compared with 1600 ml, range 600-6000, p = 0.02), and women were more likely to develop anastomotic leaks than men (15/70 compared with 3/74, p = 0.009).
Conclusion:
We conclude that so far the stapled anastomoses have given superior results, but it remains to be seen whether other differences will emerge as length of follow up increases.