Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: A multicenter study

Demetrios Demetriades, James A. Murray, Linda S. Chan, C. Ordoñez, D. Bowley, Kimberly K. Nagy, Edward E. Cornwell, George C. Velmahos, N. Muñoz, C. Hatzitheofilou, C. William Schwab, Aurelio Rodriguez, C. Cornejo, Kimberly A. Davis, Nicholas Namias, David H Wisner, Rao R. Ivatury, Ernest E. Moore, Jose A. Acosta, Kimball I. MaullMichael H. Thomason, David A. Spain

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma. Methods: This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs. Results: Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8%) the anastomosis was performed with handsewing and in the remaining 79 (38.2%) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7% (26.6% in the stapled group and 20.3% in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3% in the stapled group and 7.8% in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95% CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95% CI, 0.46-2.11, p = 0.99). Conclusion: The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.

Original languageEnglish (US)
Pages (from-to)117-121
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume52
Issue number1
StatePublished - 2002

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Multicenter Studies
Colon
Wounds and Injuries
Blood Transfusion
Incidence
Multivariate Analysis
Odds Ratio
Equipment and Supplies
Anastomotic Leak
Antibiotic Prophylaxis
Hypotension
Emergencies
Logistic Models
Regression Analysis
Prospective Studies
Safety

ASJC Scopus subject areas

  • Surgery

Cite this

Demetriades, D., Murray, J. A., Chan, L. S., Ordoñez, C., Bowley, D., Nagy, K. K., ... Spain, D. A. (2002). Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: A multicenter study. Journal of Trauma - Injury, Infection and Critical Care, 52(1), 117-121.

Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection : A multicenter study. / Demetriades, Demetrios; Murray, James A.; Chan, Linda S.; Ordoñez, C.; Bowley, D.; Nagy, Kimberly K.; Cornwell, Edward E.; Velmahos, George C.; Muñoz, N.; Hatzitheofilou, C.; William Schwab, C.; Rodriguez, Aurelio; Cornejo, C.; Davis, Kimberly A.; Namias, Nicholas; Wisner, David H; Ivatury, Rao R.; Moore, Ernest E.; Acosta, Jose A.; Maull, Kimball I.; Thomason, Michael H.; Spain, David A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 52, No. 1, 2002, p. 117-121.

Research output: Contribution to journalArticle

Demetriades, D, Murray, JA, Chan, LS, Ordoñez, C, Bowley, D, Nagy, KK, Cornwell, EE, Velmahos, GC, Muñoz, N, Hatzitheofilou, C, William Schwab, C, Rodriguez, A, Cornejo, C, Davis, KA, Namias, N, Wisner, DH, Ivatury, RR, Moore, EE, Acosta, JA, Maull, KI, Thomason, MH & Spain, DA 2002, 'Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: A multicenter study', Journal of Trauma - Injury, Infection and Critical Care, vol. 52, no. 1, pp. 117-121.
Demetriades, Demetrios ; Murray, James A. ; Chan, Linda S. ; Ordoñez, C. ; Bowley, D. ; Nagy, Kimberly K. ; Cornwell, Edward E. ; Velmahos, George C. ; Muñoz, N. ; Hatzitheofilou, C. ; William Schwab, C. ; Rodriguez, Aurelio ; Cornejo, C. ; Davis, Kimberly A. ; Namias, Nicholas ; Wisner, David H ; Ivatury, Rao R. ; Moore, Ernest E. ; Acosta, Jose A. ; Maull, Kimball I. ; Thomason, Michael H. ; Spain, David A. / Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection : A multicenter study. In: Journal of Trauma - Injury, Infection and Critical Care. 2002 ; Vol. 52, No. 1. pp. 117-121.
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abstract = "Background: Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma. Methods: This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs. Results: Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8{\%}) the anastomosis was performed with handsewing and in the remaining 79 (38.2{\%}) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7{\%} (26.6{\%} in the stapled group and 20.3{\%} in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3{\%} in the stapled group and 7.8{\%} in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95{\%} CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95{\%} CI, 0.46-2.11, p = 0.99). Conclusion: The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.",
author = "Demetrios Demetriades and Murray, {James A.} and Chan, {Linda S.} and C. Ordo{\~n}ez and D. Bowley and Nagy, {Kimberly K.} and Cornwell, {Edward E.} and Velmahos, {George C.} and N. Mu{\~n}oz and C. Hatzitheofilou and {William Schwab}, C. and Aurelio Rodriguez and C. Cornejo and Davis, {Kimberly A.} and Nicholas Namias and Wisner, {David H} and Ivatury, {Rao R.} and Moore, {Ernest E.} and Acosta, {Jose A.} and Maull, {Kimball I.} and Thomason, {Michael H.} and Spain, {David A.}",
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T1 - Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection

T2 - A multicenter study

AU - Demetriades, Demetrios

AU - Murray, James A.

AU - Chan, Linda S.

AU - Ordoñez, C.

AU - Bowley, D.

AU - Nagy, Kimberly K.

AU - Cornwell, Edward E.

AU - Velmahos, George C.

AU - Muñoz, N.

AU - Hatzitheofilou, C.

AU - William Schwab, C.

AU - Rodriguez, Aurelio

AU - Cornejo, C.

AU - Davis, Kimberly A.

AU - Namias, Nicholas

AU - Wisner, David H

AU - Ivatury, Rao R.

AU - Moore, Ernest E.

AU - Acosta, Jose A.

AU - Maull, Kimball I.

AU - Thomason, Michael H.

AU - Spain, David A.

PY - 2002

Y1 - 2002

N2 - Background: Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma. Methods: This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs. Results: Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8%) the anastomosis was performed with handsewing and in the remaining 79 (38.2%) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7% (26.6% in the stapled group and 20.3% in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3% in the stapled group and 7.8% in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95% CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95% CI, 0.46-2.11, p = 0.99). Conclusion: The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.

AB - Background: Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma. Methods: This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs. Results: Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8%) the anastomosis was performed with handsewing and in the remaining 79 (38.2%) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7% (26.6% in the stapled group and 20.3% in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3% in the stapled group and 7.8% in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95% CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95% CI, 0.46-2.11, p = 0.99). Conclusion: The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.

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