Stapled vs Conventional Hand-sewn Gastrointestinal Anastomosis during Infancy: A Prospective Comparative Study from Central India

Abstract

Background The creation of a joint between two bowel ends in newborns and infants is one of the core surgical procedures in pediatric surgery. For a proper and perfect gastrointestinal (GI) anastomosis, the factors to be considered are intraoperative duration, restoration of normal GI function, effective hemostasis, reduction of tissue damage, and prevention of postoperative mortality and morbidity. The safety and efficacy of stapled GI tract anastomosis in adults have been extensively documented; however, available literature on the same is limited for infants. Materials and methods Fifty-six patients were divided into two groups—stapled group and hand-sewn group. Patients operated on both emergency and elective basis were included in the study. Hand-sewn anastomosis was done by either end-to-end single-layer or double-layer anastomosis. Suture material used for the anastomosis was Vicryl 3-0 or Vicryl 4-0. Stapled anastomosis was done by 55 mm linear cutting GI stapler with side-to-side anastomosis. Results The present study included a total of 56 patients; there were 28 neonates and 28 infants; 37 of them were males. The most common clinical presentations were vomiting, abdominal distention, refusal to feed, and lethargy. The intraoperative duration in stapled GI anastomosis was less when compared to hand-sewn anastomosis, so was the return of bowel activity and consequently early initiation of feeds and shorter hospital stay. Conclusion The present study favors stapled over hand-sewn GI anastomosis in infancy in view of decreased intraoperative duration, reduced blood loss, early return of peristalsis, early initiation of feeds, and shorter duration of hospital stay. However, a small number of patients and lack of matching are the shortcomings of this study. How to cite this article Mitra AS, Chandak U, Kulkarni KK, et al. Stapled vs Conventional Hand-sewn Gastrointestinal Anastomosis during Infancy: A Prospective Comparative Study from Central India. Euroasian J Hepato-Gastroenterol 2020;10(1):11–15.

Stapled versus hand-sewn intestinal anastomosis in pediatric patients: a systematic review and meta-analysis

“…After full-text article screening, nine studies were excluded for the following reasons: included adults (n = 6), included pediatric patients older than 7 years (n = 1), non-comparative study (n = 1), and anastomosis underwent laparoscopically (n = 1). Finally, six studies were included in the meta-analysis [ 5 – 10 ].…”

“…Table 3 shows the risk of bias assessment of the included RCTs [ 10 ]. There was some concern about bias arising from the randomization process because randomization was performed by allotting patients to each group alternately.…”

“…The overall rate of anastomotic leakage was not significantly different between the SA and HA groups (6.5 % vs. 7.4 %, OR, 0.93; 95 % CI, 0.37–2.34; p = 0.88; I 2 = 0 %) (Fig. 2 a) [ 7 – 10 ]. In the subgroup analysis of patients aged < 1 year, the overall rate of anastomotic leakage showed no significant difference between SA and HA groups (7.1 % vs. 7.7 %, OR, 0.95; 95 % CI, 0.34–2.68; p = 0.92; I 2 = 0 %) (Fig.…”

“…In the subgroup analysis of patients aged < 1 year, the overall rate of anastomotic leakage showed no significant difference between SA and HA groups (7.1 % vs. 7.7 %, OR, 0.95; 95 % CI, 0.34–2.68; p = 0.92; I 2 = 0 %) (Fig. 2 b) [ 8 – 10 ].…”

“…Since Powell reported the usefulness of SA in infants younger than 5 months in 1995 [ 4 ], reports of SA in pediatric patients have gradually increased [ 5 – 12 ]. These studies reported that SA had the same frequency of complications as HA had [ 5 – 11 ], and SA had a shorter operative time [ 5 , 6 , 10 , 11 ], an earlier time until initial feeding [ 9 , 10 ], and a shorter length of hospital stay than had HA [ 10 ]. However, the number of cases in these studies was small, and the effectiveness of SA has not yet been confirmed.…”