Stapled vs Hand-Sutured lleoanal Anastomosis in Restorative Proctocolectomy

TLDR

A prospective, randomized study compared hand‑sutured (n = 19) versus double‑stapled (n = 21) ileoanal anastomosis in 40 patients undergoing restorative proctocolectomy to assess complications and functional outcomes. Double‑stapled ileoanal anastomosis had a higher complication rate (57 % vs 42 %) and did not improve functional outcomes compared to hand‑sutured anastomosis, leaving residual disease.

Abstract

A prospective, randomized study of hand-sutured (group 1, n = 19) and double-stapled (group 2, n = 21) ileoanal anastomosis was carried out in 40 consecutive patients during restorative proctocolectomy to compare complications and functional outcome. Eight patients (42%) in group 1 and 12 (57%) in group 2 had one or more complications. Four patients in group 1 and five in group 2 developed pelvic sepsis. One stapled anastomosis had to be converted to a hand-sutured one because of severe anastomotic stricture. Four patients in group 1 and eight in group 2 had no nighttime evacuations 3 months after surgery and seven patients in group 1 and 11 in group 2 had no nighttime evacuations six months after surgery. Mucous leakage occurred in two vs five patients after 6 months in groups 1 and 2, respectively. The mean resting anal pressure decreased 30% in group 1 and 28% in group 2. In conclusion, double-stapled ileoanal anastomosis does not offer any functional or technical advantage over hand-sutured anastomosis, but it does leave some of the disease behind.