SUPRAPERITONEAL COLORECTAL ANASTOMOSIS - HAND-SEWN VERSUS CIRCULAR STAPLES - A CONTROLLED CLINICAL-TRIAL

被引:74
作者
FINGERHUT, A
HAY, JM
ELHADAD, A
LACAINE, F
FLAMANT, Y
机构
关键词
D O I
10.1016/S0039-6060(05)80362-9
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Although used widely for supraperitoneal anastomoses, circular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied these anastomoses specifically, the only signiificant difference found was that there were more clinically obvious leakages with the circular stapled variety, but not in the overall clinical and roentgenologic leakage rates. Methods. One hundred fifty-nine consecutive patients (88 men and 71 women, mean age 65.8 +/- 12.1 years) were randomizes to undergo hand-sewn (n = 74) or circular stapled (n = 85) supraperitoneal colorectal anastomosis after left colectomy. Results. Patient demographics were similar in both groups. Overall mortality was 1.3% (2 of 159 one in each group). No statistically significant difference (NS) was found in the rate of early complications, including anastomotic leakage (4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, respectively). Mishaps (n = 10) and hemorrhage (n = 5) occurred in the stapled group only. Stapled anastomoses took an average of 8 minutes less to perform (p < 0.001), but this time gain did not significantly influence the overall duration of operation (identical median times). The median duration of hospitalization was 13 and 14 days, respectively (NS). At 8 months there were 2 of 74 strictures in the hand-sewn group and 4 of 85 strictures in the stapled group (NS). Conclusions. According to these results, there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal colerectal anastomosis.
引用
收藏
页码:479 / 485
页数:7
相关论文
共 33 条
[1]   INTRAOPERATIVE AIR TESTING OF COLORECTAL ANASTOMOSES - A PROSPECTIVE, RANDOMIZED TRIAL [J].
BEARD, JD ;
NICHOLSON, ML ;
SAYERS, RD ;
LLOYD, D ;
EVERSON, NW .
BRITISH JOURNAL OF SURGERY, 1990, 77 (10) :1095-1097
[2]  
BOLTON RA, 1980, LANCET, V19, P850
[3]   STAPLES OR SUTURES FOR COLONIC ANASTOMOSES - A CONTROLLED CLINICAL-TRIAL [J].
BRENNAN, SS ;
PICKFORD, IR ;
EVANS, M ;
POLLOCK, AV .
BRITISH JOURNAL OF SURGERY, 1982, 69 (12) :722-724
[4]  
BRODMAN RF, 1981, ARCH SURG-CHICAGO, V116, P191
[5]  
CAJOZZO M, 1990, ACTA CHIR SCAND, V156, P167
[6]  
CHASSIN JL, 1984, SURG CLIN N AM, V64, P441
[7]   ADVANTAGES OF HANDSEWN OVER STAPLED BOWEL ANASTOMOSIS [J].
DZIKI, AJ ;
DUNCAN, MD ;
HARMON, JW ;
SAINI, N ;
MALTHANER, RA ;
TRAD, KS ;
FERNICOLA, MT ;
HAKKI, F ;
UGARTE, RM .
DISEASES OF THE COLON & RECTUM, 1991, 34 (06) :442-448
[8]   COMPARISON OF STAPLING AND HAND-SUTURE FOR LEFT-SIDED LARGE-BOWEL ANASTOMOSIS [J].
EVERETT, WG ;
FRIEND, PJ ;
FORTY, J .
BRITISH JOURNAL OF SURGERY, 1986, 73 (05) :345-348
[9]  
FIELDING LP, 1978, LANCET, V2, P778
[10]  
FRIEND PJ, 1990, SURG GYNECOL OBSTET, V171, P373