- Email: [email protected]
Anastomotic technique and survival after right hemicolectomy for colorectal cancer
Original Article
Anastomotic technique and survival after right hemicolectomy for colorectal cancer
S. Anwar S. Hughes A. J. Eadie N. A. Scott Department of Colorectal Surgery, Hope Hospital, Salford, Manchester,UK Correspondence to: S. Anwar, Specialist Registrar, Department of General Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK Email: [email protected]
Aim: To compare the long-term outcome of patients after right hemicolectomy for colorectal cancer undergoing ileocolonic reconstruction either by a sutured technique or by side-to-side stapled anastomosis. Methods: Single surgeon series from 1992 to 2001 comprising 100 consecutive patients, 59 with hand sutured reconstruction and 41 undergoing TLC 55mm stapled side-toside anastomosis. Details of gender, patient age, and elective versus emergency presentation, Dukes stage, and curative versus palliative resection were recorded prospectively. In addition, post-operative hospital stay and subsequent survival were determined by prospective protocol follow-up. Results: Overall 24% of the patients studied presented as emergencies and underwent a palliative procedure. There were no anastomotic leaks in either the stapled or sutured groups. Hospital mortality was also not significantly different – stapled reconstruction, 7%, sutured reconstruction, 10% (p value 0.624). Overall long-term cancer outcome was the same for both anastomotic techniques, both stapled and sutured groups having a median survival of 2.9 years. Conclusions: Stapled ileocolonic reconstruction after right hemicolectomy for colonic carcinoma is a safe and reliable surgical technique associated with long-term cancer outcomes comparable with those obtained by the sutured anastomotic technique. Keywords: Right hemicolectomy, anastomotic leak, colorectal cancer, stapled anastomosis, sutured anastomosis Surg J R Coll Surg Edinb Irel., 2 October 2004, 277-280
INTRODUCTION Mechanical stapling devices are now used widely for gastrointestinal surgery.1 A better blood supply, reduced tissue manipulation, minimum oedema, uniformity of sutures, adequate lumen, and rapidity of operation are proposed benefits of this technique.2-6 Comparable anastomotic leak rates are reported for stapled and hand sewn techniques.7-19 However, the majority of comparisons have been made for left-sided anastomoses. There is also a paucity of literature relating to the effect of either anastomotic technique on cancer survival, specifically in patients undergoing right hemicolectomy. © 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311
The aim of this study was to determine, from a consecutive series of ileocolonic anastomoses, the short-term morbidity and long-term survival outcome of patients having stapled anastomoses, compared with patients having hand sutured anastomoses, after colonic carcinoma resection and ileocolonic reconstruction.
MATERIALS AND METHODS Data was collected prospectively on 100 consecutive patients who underwent right hemicolectomy for right colonic adenocarcinomas. This was a single surgeon series (senior author) between 1992–2001. The Royal Colleges of Surgeons of Edinburgh and Ireland
277
Randomisation was not carried out and the choice of technique reflected the authors changing practice from sutured to stapled anastomoses. The total number of patients in the stapled group was 41 with a male to female ratio (m:f) of 21:20. There were 59 patients in the sutured group with a m:f ratio of 27:32. The age range for the stapled group was 30-89 years with a median of 74 years, whereas the age range for the sutured group was 3891 years with a median of 73 years. Sutured anastomoses were performed in two layers using 3-0 maxon, outer interrupted and inner continuous layer. The stapled anastomosis was performed side-to-side using the TLC 55mm (Ethicon
Endosurgery Inc.USA) gun, the defect being closed with two layers of maxon.
RESULTS Overall, 76 elective ileocolonic operations were carried out and 24 emergency procedures were done (Table 1). Thirty five patients in the stapled group were elective as were 41 patients in the sutured group. The large majority of patients in both groups had Dukes B and C tumours. Resection was done with a curative intent in 29 patients in the stapled group and 43 patients in the sutured group. Nine palliative procedures were done in the stapled group and 16 in the sutured group. There
TABLE 1. PATIENT CHARACTERISTICS IN THE TWO GROUPS STAPLED
SUTURED
N=41
N=59
20f:21m
32f:27m
A
2
2
B
19
36
C
17
18
Unknown
3
3
Elective
35
41
Emergency
6
18
Yes
3
6
No
38
53
Curative
29
43
Palliative
9
16
Unknown
3
0
Age (median range)
74yrs (30-89)
73yrs (38-91)
Stay (median range)
14.5 days (8-71)
11.5 days (1-33)
2.9yrs
2.9yrs
Gender Stage
Presentation
Post-operative death
Survival median
278
The Royal Colleges of Surgeons of Edinburgh and Ireland
© 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311
were three deaths in the stapled group and six in the sutured group; none of these had any clinical evidence of a leak. The difference between the two groups was shown to be statistically non-significant, by chi square test (p value 0.624). Post-mortem studies confirmed the anastomses to be intact; cardio-respiratory pathology being the main cause of death in the majority of the patients. The median hospital stay in the stapled group was 14.5 days and 11.5 days in the sutured group. This difference was not statistically significant (p value 0.357). Complete follow-up data were available on all 100 patients up to five years or until death. The duration of median survival for both anastomotic techniques was 2.9 years.
DISCUSSION This study indicates that the immediate anastomotic outcome for stapled ileocolonic anastomosis is identical to that of hand sutured ileocolonic reconstruction. Previous studies of anastomotic techniques after right hemicolectomy (Table 2) have indicated similar good short-term results for stapled ileocolonic anastomosis.20-25 A randomised study of 440 patients, allocated to either manual or stapled reconstruction after right hemicolectomy for colorectal cancer, showed stapled anastomoses had a lower
leakage rate (2.8%) than the hand sutured technique (8.3%).20 Other randomised and non-randomised studies of anastomotic technique have shown similar leak rates for stapled and sutured techniques.21-25,28 However, emergency operations and/or the presence of bacterial or faecal leakage in patients are said to be associated with an increased risk of anastomotic leakage.26 In this small series, none of the emergency resections was associated with these complications. Beside short-term outcome, the long-term survival of patients undergoing cancer surgery is of considerable interest. Wolmark et al (1986) looked at data derived from two randomised prospective trials. From a total of 1111 patients with colonic anastomosis, 255 were stapled.27 They concluded that there was no significant difference in disease-free survival, survival or local tumour recurrence among patients subjected to stapled or sutured anastomosis. In this small prospective cohort study, the median survival period for cancer patients undergoing either stapled or sutured ileocolonic anastomosis was comparable. Stapled ileocolonic anastomosis, therefore, is associated with acceptable short-term and long-term outcomes after colorectal cancer resection. COPYRIGHT 25 August 2004
TABLE 2. STUDIES COMPARING STAPLED VERSUS HAND-SEWN ANASTOMOSIS FOR BENIGN AND MALIGNANT COLONIC AND RECTAL RESECTIONS Study
Type of Study
Total no of patients
Patients with ileocolic anastomosis (stapled vs sutured) for carcinoma
Results
Brennan et al 1982 (21)
RCT
100
15:16
similar leak rates
Chassin et al 1977 (22)
RCT
812
60:38
similar complications rate
Scher et al 1982 (23)
Retrospective
242
25:27
similar complications rate
Cubertafond et al 1992 (24)
Retrospective
627
45:40
stapled anastomosis had low leak rates
Monero et al 1987 (25)
Retrospective
301
12:13
stapled anastomosis had low leak rates
Docherty et al 1995 (28)
RCT
732
70:50
similar complications rate
Kracht et al 1993 (20)
RCT
440
106:334
Stapled anastomosis had low leak rates
Note that only the study by Kratch et al (1993) has exclusively looked at right-sided ileocolonic anastomosis for colonic cancer RTC: randomised controlled trial © 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311
The Royal Colleges of Surgeons of Edinburgh and Ireland
279
REFERENCES 1. Steichen FM, Ravitch MM. History of mechanical devices and instruments for suturing. Curr Probl Surg 1982; 19: 1-52. 2. Weil PH, Scherz H. Comparison of stapled and hand sutured gastrectomies. Arch Surg 1981; 116: 14-16. 3. Smith CR, Cokelet GR, Adams JT Schwartz SI. Vascularity of gastrointestinal staple lines demonstrated with silicone rubber injection. Am J Surg 1981; 142: 563-66. 4. Wheeless CR, Smith JJ. A comparison of the flow of I 125 through three different intestinal anastomosis: standard, Gambee and stapler. Obstet Gynecol 1983; 62: 125-31. 5. Adloff M, Arnaud JP, Beehary S. Stapled vs sutured colorectal anastomosis. Arch Surg 1980;115: 1436-38. 6. Graffner H, Andersson L, Loweinhielm P, Walther B. The healing process of anastomosis of the colon. A comparative study using single, double-layer or stapled anastomosis. Dis Colon Rectum 1984; 27: 767-71. 7. Fazio VW, Jagelman DG, Lavery IC, Mcgonagle BA. Evaluation of the proximate-ILS circular stapler. A prospective study. Ann Surg 1985; 201: 108-14. 8. Dorricott NJ, Baddeley RM, Keighley MR, Lee J, Oates GD, Alexander WJ. Complications of rectal anastomosis with end-to-end anastomosis (EEA) stapling instrument. Clinical and radiological leak rates and some practical hints. Ann R Coll Surg Engl 1982;64: 171-74. 9. Kyzer S, Gordon PH. The stapled functional end-to-end anastomosis following colonic resection. Int J Colorectal Dis 1992;7; 125-31. 10. Detry RJ, Kestens PJ. Colorectal anastomosis with the EEA stapler. World J Surg 1981;5: 739-42. 11. Marti MC, Fiala JM, Rohner A. EEA stapler in large bowel surgery. World J Surg 1981;5: 735-37. 12. Steichen FM, Ravitch MM. Mechanical sutures in surgery. Br J Surg 1973;60: 191-97. 13. Vezeridis M, Evans JT, Mittleman A, Ledesma EJ. EEA stapler in low anterior anastomosis. Dis Colon Rectum 1982;25: 364-67. 14. Beart RW, Kelly KA. Randomized prospective evaluation of the EEA stapler for colorectal anastomosis. Am J Surg 1981;141: 143-47. 15. Reiling RB, Reiling WA, Bernie WA, Huffer AB, Perkins NC, Elliott DW. Prospective controlled study of gastrointestinal stapled anastomosis. Am J Surg 1980;139: 147-52.
circular staples. A controlled clinical trial. French Associations for Surgical Research. Surgery 1994;116: 484-90. 17. Elhadad A. Colorectal anastomosis: manual or mechanical? A controlled multicenter study. Chirurgie 1990;116:425-28. 18. Didolkar MS, Reed WP, Elias EG, Schnaper LA, Brown SD, Chaudhary SM. A prospective randomized study of sutured versus stapled bowel anastomosis in patients with cancer. Cancer 1986;57: 456-60. 19. Everett WG, Friend PJ, Forty J. Comparison of stapling and hand-suture for left-sided large bowel anastomosis. Br J Surg 1986;73:345-48. 20. Kracht M, Hay JM, Fagniez PL, Fingerhut A. Ileocolonic anastomosis after right hemicolectomy for carcinoma: stapled or hand-sewn. A prospective, multicenter, randomized trial. Int J Colorectal Dis 1993;8: 29-33. 21. Brennan SS, Pickford IR, Evans M, Pollock AV. Staples or sutures for colonic anastomosis: a controlled clinical trial. Br J Surg 1982;69: 722-24. 22. Chassin JL, Rifkind KM, Sussman B, Kassel B, Fingaret A, Drager S, Chassin PS. The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis. Ann Surg 1978;188: 689-96. 23. Scher KS, Scott-Conner C, Jones CW, Leach M. A comparison of stapled and sutured anastomosis in colonic operations. Surg Gynecol Obstet 1982;155; 489-93. 24. Cubertafond P, Cucchiaro G, Lesourd-Pontonnier F, Gainant A. Early post-operative complications of resection anastomosis in colonic and colorectal surgery. An analysis of 624 cases. Chirurgie 1992;118: 86-91. 25. Moreno-Gonzalez E, Vara-Trorback R. Stapled versus manual anastomosis in gastrointestinal surgery. Langenbecks Arch Chir 1987;372: 99-103. 26. Schrock TR, Deveney CW and Dunphy JE. Factors contributing to leakage of colonic anastomosis. Ann Surg 1973;177: 513-18 27. Wolmark N, Gordon P, Fisher B, Weiand S, Lerner H, Lawrence W, Shibata H. A comparison of stapled and handsewn anastomosis in patients undergoing resection for Dukes B and C colorectal cancer. Dis Colon Rectum 1986;29:344-50. 28. Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ. Comparison of manually constructed and stapled anastomoses in colorectal surgery. Ann Surg 1995;221:176-84.
16. Fingerhut A, Elhadad A, Hay JM, Lacaine F, Flamant Y. Infraperitoneal colorectal anastomosis: hand-sewn versus 280
The Royal Colleges of Surgeons of Edinburgh and Ireland
© 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311
Anastomotic technique and survival after right hemicolectomy for colorectal cancer
S. Anwar S. Hughes A. J. Eadie N. A. Scott Department of Colorectal Surgery, Hope Hospital, Salford, Manchester,UK Correspondence to: S. Anwar, Specialist Registrar, Department of General Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK Email: [email protected]
Aim: To compare the long-term outcome of patients after right hemicolectomy for colorectal cancer undergoing ileocolonic reconstruction either by a sutured technique or by side-to-side stapled anastomosis. Methods: Single surgeon series from 1992 to 2001 comprising 100 consecutive patients, 59 with hand sutured reconstruction and 41 undergoing TLC 55mm stapled side-toside anastomosis. Details of gender, patient age, and elective versus emergency presentation, Dukes stage, and curative versus palliative resection were recorded prospectively. In addition, post-operative hospital stay and subsequent survival were determined by prospective protocol follow-up. Results: Overall 24% of the patients studied presented as emergencies and underwent a palliative procedure. There were no anastomotic leaks in either the stapled or sutured groups. Hospital mortality was also not significantly different – stapled reconstruction, 7%, sutured reconstruction, 10% (p value 0.624). Overall long-term cancer outcome was the same for both anastomotic techniques, both stapled and sutured groups having a median survival of 2.9 years. Conclusions: Stapled ileocolonic reconstruction after right hemicolectomy for colonic carcinoma is a safe and reliable surgical technique associated with long-term cancer outcomes comparable with those obtained by the sutured anastomotic technique. Keywords: Right hemicolectomy, anastomotic leak, colorectal cancer, stapled anastomosis, sutured anastomosis Surg J R Coll Surg Edinb Irel., 2 October 2004, 277-280
INTRODUCTION Mechanical stapling devices are now used widely for gastrointestinal surgery.1 A better blood supply, reduced tissue manipulation, minimum oedema, uniformity of sutures, adequate lumen, and rapidity of operation are proposed benefits of this technique.2-6 Comparable anastomotic leak rates are reported for stapled and hand sewn techniques.7-19 However, the majority of comparisons have been made for left-sided anastomoses. There is also a paucity of literature relating to the effect of either anastomotic technique on cancer survival, specifically in patients undergoing right hemicolectomy. © 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311
The aim of this study was to determine, from a consecutive series of ileocolonic anastomoses, the short-term morbidity and long-term survival outcome of patients having stapled anastomoses, compared with patients having hand sutured anastomoses, after colonic carcinoma resection and ileocolonic reconstruction.
MATERIALS AND METHODS Data was collected prospectively on 100 consecutive patients who underwent right hemicolectomy for right colonic adenocarcinomas. This was a single surgeon series (senior author) between 1992–2001. The Royal Colleges of Surgeons of Edinburgh and Ireland
277
Randomisation was not carried out and the choice of technique reflected the authors changing practice from sutured to stapled anastomoses. The total number of patients in the stapled group was 41 with a male to female ratio (m:f) of 21:20. There were 59 patients in the sutured group with a m:f ratio of 27:32. The age range for the stapled group was 30-89 years with a median of 74 years, whereas the age range for the sutured group was 3891 years with a median of 73 years. Sutured anastomoses were performed in two layers using 3-0 maxon, outer interrupted and inner continuous layer. The stapled anastomosis was performed side-to-side using the TLC 55mm (Ethicon
Endosurgery Inc.USA) gun, the defect being closed with two layers of maxon.
RESULTS Overall, 76 elective ileocolonic operations were carried out and 24 emergency procedures were done (Table 1). Thirty five patients in the stapled group were elective as were 41 patients in the sutured group. The large majority of patients in both groups had Dukes B and C tumours. Resection was done with a curative intent in 29 patients in the stapled group and 43 patients in the sutured group. Nine palliative procedures were done in the stapled group and 16 in the sutured group. There
TABLE 1. PATIENT CHARACTERISTICS IN THE TWO GROUPS STAPLED
SUTURED
N=41
N=59
20f:21m
32f:27m
A
2
2
B
19
36
C
17
18
Unknown
3
3
Elective
35
41
Emergency
6
18
Yes
3
6
No
38
53
Curative
29
43
Palliative
9
16
Unknown
3
0
Age (median range)
74yrs (30-89)
73yrs (38-91)
Stay (median range)
14.5 days (8-71)
11.5 days (1-33)
2.9yrs
2.9yrs
Gender Stage
Presentation
Post-operative death
Survival median
278
The Royal Colleges of Surgeons of Edinburgh and Ireland
© 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311
were three deaths in the stapled group and six in the sutured group; none of these had any clinical evidence of a leak. The difference between the two groups was shown to be statistically non-significant, by chi square test (p value 0.624). Post-mortem studies confirmed the anastomses to be intact; cardio-respiratory pathology being the main cause of death in the majority of the patients. The median hospital stay in the stapled group was 14.5 days and 11.5 days in the sutured group. This difference was not statistically significant (p value 0.357). Complete follow-up data were available on all 100 patients up to five years or until death. The duration of median survival for both anastomotic techniques was 2.9 years.
DISCUSSION This study indicates that the immediate anastomotic outcome for stapled ileocolonic anastomosis is identical to that of hand sutured ileocolonic reconstruction. Previous studies of anastomotic techniques after right hemicolectomy (Table 2) have indicated similar good short-term results for stapled ileocolonic anastomosis.20-25 A randomised study of 440 patients, allocated to either manual or stapled reconstruction after right hemicolectomy for colorectal cancer, showed stapled anastomoses had a lower
leakage rate (2.8%) than the hand sutured technique (8.3%).20 Other randomised and non-randomised studies of anastomotic technique have shown similar leak rates for stapled and sutured techniques.21-25,28 However, emergency operations and/or the presence of bacterial or faecal leakage in patients are said to be associated with an increased risk of anastomotic leakage.26 In this small series, none of the emergency resections was associated with these complications. Beside short-term outcome, the long-term survival of patients undergoing cancer surgery is of considerable interest. Wolmark et al (1986) looked at data derived from two randomised prospective trials. From a total of 1111 patients with colonic anastomosis, 255 were stapled.27 They concluded that there was no significant difference in disease-free survival, survival or local tumour recurrence among patients subjected to stapled or sutured anastomosis. In this small prospective cohort study, the median survival period for cancer patients undergoing either stapled or sutured ileocolonic anastomosis was comparable. Stapled ileocolonic anastomosis, therefore, is associated with acceptable short-term and long-term outcomes after colorectal cancer resection. COPYRIGHT 25 August 2004
TABLE 2. STUDIES COMPARING STAPLED VERSUS HAND-SEWN ANASTOMOSIS FOR BENIGN AND MALIGNANT COLONIC AND RECTAL RESECTIONS Study
Type of Study
Total no of patients
Patients with ileocolic anastomosis (stapled vs sutured) for carcinoma
Results
Brennan et al 1982 (21)
RCT
100
15:16
similar leak rates
Chassin et al 1977 (22)
RCT
812
60:38
similar complications rate
Scher et al 1982 (23)
Retrospective
242
25:27
similar complications rate
Cubertafond et al 1992 (24)
Retrospective
627
45:40
stapled anastomosis had low leak rates
Monero et al 1987 (25)
Retrospective
301
12:13
stapled anastomosis had low leak rates
Docherty et al 1995 (28)
RCT
732
70:50
similar complications rate
Kracht et al 1993 (20)
RCT
440
106:334
Stapled anastomosis had low leak rates
Note that only the study by Kratch et al (1993) has exclusively looked at right-sided ileocolonic anastomosis for colonic cancer RTC: randomised controlled trial © 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311
The Royal Colleges of Surgeons of Edinburgh and Ireland
279
REFERENCES 1. Steichen FM, Ravitch MM. History of mechanical devices and instruments for suturing. Curr Probl Surg 1982; 19: 1-52. 2. Weil PH, Scherz H. Comparison of stapled and hand sutured gastrectomies. Arch Surg 1981; 116: 14-16. 3. Smith CR, Cokelet GR, Adams JT Schwartz SI. Vascularity of gastrointestinal staple lines demonstrated with silicone rubber injection. Am J Surg 1981; 142: 563-66. 4. Wheeless CR, Smith JJ. A comparison of the flow of I 125 through three different intestinal anastomosis: standard, Gambee and stapler. Obstet Gynecol 1983; 62: 125-31. 5. Adloff M, Arnaud JP, Beehary S. Stapled vs sutured colorectal anastomosis. Arch Surg 1980;115: 1436-38. 6. Graffner H, Andersson L, Loweinhielm P, Walther B. The healing process of anastomosis of the colon. A comparative study using single, double-layer or stapled anastomosis. Dis Colon Rectum 1984; 27: 767-71. 7. Fazio VW, Jagelman DG, Lavery IC, Mcgonagle BA. Evaluation of the proximate-ILS circular stapler. A prospective study. Ann Surg 1985; 201: 108-14. 8. Dorricott NJ, Baddeley RM, Keighley MR, Lee J, Oates GD, Alexander WJ. Complications of rectal anastomosis with end-to-end anastomosis (EEA) stapling instrument. Clinical and radiological leak rates and some practical hints. Ann R Coll Surg Engl 1982;64: 171-74. 9. Kyzer S, Gordon PH. The stapled functional end-to-end anastomosis following colonic resection. Int J Colorectal Dis 1992;7; 125-31. 10. Detry RJ, Kestens PJ. Colorectal anastomosis with the EEA stapler. World J Surg 1981;5: 739-42. 11. Marti MC, Fiala JM, Rohner A. EEA stapler in large bowel surgery. World J Surg 1981;5: 735-37. 12. Steichen FM, Ravitch MM. Mechanical sutures in surgery. Br J Surg 1973;60: 191-97. 13. Vezeridis M, Evans JT, Mittleman A, Ledesma EJ. EEA stapler in low anterior anastomosis. Dis Colon Rectum 1982;25: 364-67. 14. Beart RW, Kelly KA. Randomized prospective evaluation of the EEA stapler for colorectal anastomosis. Am J Surg 1981;141: 143-47. 15. Reiling RB, Reiling WA, Bernie WA, Huffer AB, Perkins NC, Elliott DW. Prospective controlled study of gastrointestinal stapled anastomosis. Am J Surg 1980;139: 147-52.
circular staples. A controlled clinical trial. French Associations for Surgical Research. Surgery 1994;116: 484-90. 17. Elhadad A. Colorectal anastomosis: manual or mechanical? A controlled multicenter study. Chirurgie 1990;116:425-28. 18. Didolkar MS, Reed WP, Elias EG, Schnaper LA, Brown SD, Chaudhary SM. A prospective randomized study of sutured versus stapled bowel anastomosis in patients with cancer. Cancer 1986;57: 456-60. 19. Everett WG, Friend PJ, Forty J. Comparison of stapling and hand-suture for left-sided large bowel anastomosis. Br J Surg 1986;73:345-48. 20. Kracht M, Hay JM, Fagniez PL, Fingerhut A. Ileocolonic anastomosis after right hemicolectomy for carcinoma: stapled or hand-sewn. A prospective, multicenter, randomized trial. Int J Colorectal Dis 1993;8: 29-33. 21. Brennan SS, Pickford IR, Evans M, Pollock AV. Staples or sutures for colonic anastomosis: a controlled clinical trial. Br J Surg 1982;69: 722-24. 22. Chassin JL, Rifkind KM, Sussman B, Kassel B, Fingaret A, Drager S, Chassin PS. The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis. Ann Surg 1978;188: 689-96. 23. Scher KS, Scott-Conner C, Jones CW, Leach M. A comparison of stapled and sutured anastomosis in colonic operations. Surg Gynecol Obstet 1982;155; 489-93. 24. Cubertafond P, Cucchiaro G, Lesourd-Pontonnier F, Gainant A. Early post-operative complications of resection anastomosis in colonic and colorectal surgery. An analysis of 624 cases. Chirurgie 1992;118: 86-91. 25. Moreno-Gonzalez E, Vara-Trorback R. Stapled versus manual anastomosis in gastrointestinal surgery. Langenbecks Arch Chir 1987;372: 99-103. 26. Schrock TR, Deveney CW and Dunphy JE. Factors contributing to leakage of colonic anastomosis. Ann Surg 1973;177: 513-18 27. Wolmark N, Gordon P, Fisher B, Weiand S, Lerner H, Lawrence W, Shibata H. A comparison of stapled and handsewn anastomosis in patients undergoing resection for Dukes B and C colorectal cancer. Dis Colon Rectum 1986;29:344-50. 28. Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ. Comparison of manually constructed and stapled anastomoses in colorectal surgery. Ann Surg 1995;221:176-84.
16. Fingerhut A, Elhadad A, Hay JM, Lacaine F, Flamant Y. Infraperitoneal colorectal anastomosis: hand-sewn versus 280
The Royal Colleges of Surgeons of Edinburgh and Ireland
© 2004 Surg J R Coll Surg Edinb Irel 2: 5; 249-311