Emergency Anastomosis Patients Benefit From Hand-Sewn Technique

Gastrointestinal (GI) anastomoses performed during emergencies using staples are associated with a significantly higher leak rate than those that are hand sewn, according to a new study.

Researchers at Wake Forest University (WFU; Winston-Salem, NC, USA) conducted a retrospective analysis of the outcomes of 133 stapled and 100 hand-sewn GI anastomoses performed during emergency surgery at a single clinic. Patient characteristics including age, gender, disease process, and laboratory values were similar for both groups, but surgery duration was significantly shorter (by about 12 minutes) in the stapled group. Hospital length of stay was a median of 13 days for patients with hand-sewn anastomoses, compared to nine days for the stapled group. Similar percentages of small bowel-to-small bowel, small bowel-to-colon, and colon-to-colon anastomoses were performed in both cohorts.

The results showed that 15% of the patients undergoing stapled procedures suffered anastomotic leaks, versus only 6% in the hand-sewn procedure group; mortality rates were 5.3% and 2%, respectively. Damage control laparotomy (DCL) was performed in 41 patients who had significantly higher mean preoperative lactic acid levels than the rest of the participants, with an anastomotic failure in 24% of cases, compared with only 8% for non-DCL patients. Leaks occurred at the same rate regardless of whether the anastomosis was done at the time of the initial DCL or during a subsequent operation. The study was presented at the annual meeting of the American Association for the Surgery of Trauma, held during September 2012 in Kauai (HI, USA).

“Intraoperative hypothermia, perioperative corticosteroid use, and lower admission serum albumin levels were significantly linked to anastomotic breakdown on univariate analysis,” concluded lead author and study presenter Jason Farrah, MD. “On multivariate analysis, stapled anastomosis, patient age, and admission albumin were the only significant risk factors for anastomotic leak.”

DCL involves the immediate, essential goals of control of surgical bleeding and containment of gastrointestinal soilage, achieved via a truncated laparotomy. The procedure also involves ongoing resuscitation of the injured patient in the intensive care unit (ICU). Only when the lethal triad of hypothermia, metabolic acidosis, and coagulopathy is corrected does the patient subsequently undergo definitive surgery.

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