AIM OF THE STUDY:
To study and compare the effectiveness of staplers Vs hand sewn anastomosis in gastro-intestinal surgeries in patients admitted at Government Rajaji Hospital, Madurai.
OBJECTIVES:
To derive conclusions about the advantages of staplers over conventional hand sewn anastomosis, in respect to the following paremeters :
(i) Time taken for the procedure,
(ii) Time taken for the bowel sounds to return,
(iii) Resumption of oral feeds,
(iv) Post operative hospital stay,
(v) Incidence of complications: Anastomotic bleed, Anastomotic leak, Anastomotic stricture.
MATERIALS AND METHODS:
This is a hospital based comparative type of study. A minimum of 50 cases (25 in each group) which meets the inclusion & exclusion criteria are included in this hospital based comparative study.
Study place:
Department of General Surgery, Madurai Medical College, Madurai.
Study duration:
November 2017 to September 2018.
Eligibility Criteria:
Inclusion criteria:
1. All patients admitted to the general surgery wards requiring elective as well asemergency gastro-intestinal surgeries who undergo bowel anastomosis for various benign and malignant conditions.
2. Male or female subjects between the ages of 12 and 80 yrs undergoing various gastrointestinal surgeries.
3. Subjects who gave written informed consent after reviewing the informed consent document.
Exclusion criteria:
1. Age less than 12 yrs and more than 80 yrs.
2. All pregnant patients.
3. Patients undergoing radiotherapy.
4. Patients of coagulopathy & patients on anti-coagulation.
5. Patientswho not consented for inclusion in the study.
DISSCUSSION:
In this study, a total of 50 cases who are admitted in GRH, Madurai for either benign or malignant condition requiring resection and anastomosis from the period of September 2017 to September 2018 are included. The cases are chosen randomly for the stapler group (25 cases) and the hand sewn group (25 cases).
Among them most of the cases are males (80%). The median age group in the stapler group is 53, while in hand sewn group is 52. The p value is 0.662 and is statistically insignificant. Malignant conditions of the GI tract accounted for majority of the condition where resection and anastomosis is performed (31 out of 50 cases). P value in the groups are 1.0 and so it is statistically insignificant.
The mean operating time in stapler group is 252 minutes, while in the hand sewn group it is 272 minutes. P value is < 0.001 and is statistically significant. The time of appearance of bowel sounds and the resumption of oral feeds are also earlier in stapler group with a significant p value.
The cases are followed up till discharge. No cases are lost in the follow up period. The complications encountered are anastomotic leak (4 in stapler, 3 in hand sewn), anastomotic bleed (1 in stapler, 1 in hand sewn), and anastomotic stricture (2 in stapler group, 1 in hand sewn group). P value is 0.892 and is statistically insignificant. So the incidence of complications are similar in both the stapler group and the hand sewn group.
CONCLUSION:
From the above data analyzed, I conclude that stapler anastomosis is superior to the conventional hand sewn anastomosis in terms of: lesser operative time, earlier return of bowel sounds and the resumption of oral feeds, lesser duration of hospital stay. In terms of the incidence of complications such as anastomotic leak, there is no significant difference observed in both the groups. So the complications will be lesser in both stapler as well as hand sewn group, if we follow the golden principles of anastomosis
