A prospective comparative study between stapler and handsewn gastrointestinal anastomosis

Abstract

Introduction: Gastrointestinal (GI) anastomosis is a critical step in bowel surgery, and the choice between stapled and handsewn techniques remains debated. Differences in operative efficiency and recovery have been reported, but complication rates appear comparable. This study compared stapled and handsewn GI anastomosis with respect to operative time, postoperative recovery, and complications. Materials and methods: A prospective observational comparative study was conducted over two years in a tertiary care center. A total of 52 patients undergoing GI anastomosis were included, with 26 in the handsewn group and 26 in the stapler group. Technique selection was surgeon-directed. Baseline demographic and clinical variables were recorded. Primary outcomes included anastomosis time, time to oral feeding, and hospital stay. Secondary outcomes included anastomotic leak, surgical site infection (SSI), wound dehiscence, morbidity, and mortality. Continuous variables were analyzed using an independent t test and categorical variables using a Chi-square test, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between groups. Anastomosis configuration differed significantly, with side-to-side performed in 26 (100%) stapled versus five (19.2%) handsewn cases (p < 0.001). Anastomotic leak occurred in two (7.7%) handsewn and three (11.5%) stapled cases (p = 0.638). SSI was seen in eight (30.8%) versus six (23.1%) (p = 0.532), and wound dehiscence in three (11.5%) versus zero (0%) (p = 0.074). The mean anastomosis time was significantly lower with stapling (5.81 ± 4.21 vs 25.62 ± 5.29 minutes, p < 0.001). Oral feeding was started earlier (2.31 ± 0.74 vs 4.27 ± 0.67 days, p < 0.001), and hospital stay was shorter (9.50 ± 2.18 vs 12.38 ± 2.12 days, p < 0.001). No mortality occurred. Conclusion: Stapled anastomosis significantly improves operative efficiency and recovery while maintaining comparable complication rates.