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Stapled versus hand-sewn anastomoses in emergency general surgery: A retrospective review of outcomes in a unique patient population

Farrah, Jason P. MD; Lauer, Cynthia W. MD; Bray, Mallory S. MD; McCartt, Jason M. MD; Chang, Michael C. MD; Meredith, J.Wayne MD; Miller, Preston R. MD; Mowery, Nathan T. MD

Journal of Trauma and Acute Care Surgery:
doi: 10.1097/TA.0b013e31828cc9c4
CME Articles
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Abstract

BACKGROUND: Recent studies have identified unique clinical and physiologic characteristics of emergency general surgery (EGS) patients and called for outcomes data in this population. There are no data in the US literature analyzing the impact of technique on anastomotic failure rates in EGS patients. The purpose of the current study was to compare outcomes of hand-sewn (HS) versus stapled (ST) bowel anastomoses in EGS patients.

METHODS: A retrospective chart review of all patients admitted by our EGS service undergoing bowel resection for emergent indications from January 2007 to July 2011 was performed. Time from surgery to diagnosis of anastomotic failure was recorded as were the diagnostic modality and treatment of each anastomotic failure. Specific data on damage-control techniques, if used, were also collected.

RESULTS: There were 100 HS (43%), and 133 ST (57%) anastomoses in 231 patients. Operative times were shorter in ST anastomosis technique (205 minutes for HS vs. 193 minutes for ST, p = 0.02). Anastomotic failures were identified in 26 patients (11%) and were significantly higher in the ST group than the HS group (15.0% vs. 6.1%, p = 0.003). A multivariate logistic regression analysis, controlling for age and preoperative nutritional status, revealed ST technique to be an independent risk factor for anastomotic failure (odds ratio, 2.65; 95% confidence interval, 1.08–6.50; p = 0.034).

CONCLUSION: Anastomotic failures are more than twice as likely with ST than HS anastomoses in the EGS population. This is true even when controlling for markers of preoperative nutrition and demographics. These data suggest that the HS anastomosis should be the preferred method of reconstruction after bowel resection in EGS patients.

LEVEL OF EVIDENCE: Therapeutic study, level IV.

Author Information

From the Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.

Submitted: November 5, 2012, Revised: January 11, 2013, Accepted: January 11, 2013.

This study was presented as an oral presentation at the 71st American Association for the Surgery of Trauma Annual Meeting, September 12–15, 2012, in Kauai, Hawaii.

Address for reprints: Nathan T. Mowery, MD, Department of Surgery, Medical Center Boulevard, Winston-Salem, NC 27157; email: nmowery@wfubmc.edu.

© 2013 Lippincott Williams & Wilkins, Inc.