Prospective study of hand-sutured anastomosis after colorectal resection

A total of 370 patients underwent colorectal resection: 320 had a primary single-layer seromucosal anastomosis without a protective colostomy, 22 had Hartmann's procedure and 28 abdominoperineal resection. There were 260 elective procedures and 110 patients had peritonitis and/or bowel obstruction at the time of surgery. Overall the mortality rate was 2.7 per cent, the morbidity rate was 18.3 per cent and clinical anastomotic leak rate 3.4 per cent. After elective operation, the leak rate for intraperitoneal anastomosis was 0.6 per cent and for low extraperitoneal anastomosis 7 per cent. The mortality rate was 1.2 per cent and morbidity rate 11.9 per cent. Patients with peritonitis had a significant increase in morbidity rate (46 per cent) in comparison with those having elective surgery (chi 2 = 31.5, 1 d.f., P < 0.0001). Patients who had bowel obstruction and no bowel preparation had a significantly higher morbidity rate of 26 per cent and mortality rate of 7 per cent, compared with those having an elective procedure (chi 2 = 11.2, 1 d.f., P < 0.001; chi 2 = 8.7, 1 d.f., P < 0.005 respectively). Patients having palliative surgery had the highest mortality rate (19 per cent), compared with those operated on with curative intent (1.5 per cent) (chi 2 = 28.7, 1 d.f., P < 0.0001). Cost-saving hand-sutured anastomosis is effective and, in experienced hands, technically feasible after all kinds of colorectal resection and should remain the standard in colorectal surgery.