Stapled versus sutured gastrointestinal anastomoses in the trauma patient

Susan I. Brundage, Gregory Jurkovich, David C. Grossman, Wai Chung Tong, Chris D. Mack, Ronald V. Maier

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Construction of gastrointestinal anastomoses by using stapling devices has become a familiar procedure. Most studies have shown no significant differences in complication rates between stapled and sutured anastomoses performed during elective surgery. To date, no study has evaluated the incidence of complications of stapled anastomoses in the trauma patient. The purpose of our study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses after the emergent repair of traumatic bowel injuries. Methods: A retrospective analysis of the medical and institutional trauma registry records of patients identified to have undergone a gastrointestinal anastomosis in a regional Level I trauma center over a 4-year period. Results: A total of 84 patients with 118 gastrointestinal anastomoses were identified. A surgical stapling device was used to create 58 separate anastomoses, whereas a hand-sutured method was used in 60 anastomoses. A complication was defined as an anastomotic leak verified at reoperation. The ratio of blunt versus penetrating injuries, mean abdominal Abbreviated Injury Scale score, and Injury Severity Score were similar in the two groups. Stapling and suturing techniques were evenly distributed between small and large bowel repairs. Mean intensive care unit length of stay was comparable in both cohorts. However, inpatient length of stay was longer in patients with solely a stapled anastomosis compared with sutured anastomoses. Four of the 58 stapled anastomoses and none of the 60 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (relative risk = undefined; 95% confidence interval, 1.14-infinity; p = 0.037). Each anastomotic leak occurred in a separate individual. The only death occurred in the stapled cohort secondary to peritonitis and subsequent sepsis. Conclusion: Anastomotic leaks seem to be associated with stapled bowel repairs compared with sutured anastomoses in the traumatically injured patient.

Original languageEnglish (US)
Pages (from-to)500-508
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume47
Issue number3
DOIs
StatePublished - Sep 1 1999
Externally publishedYes

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Anastomotic Leak
Wounds and Injuries
Reoperation
Surgical Stapling
Length of Stay
Hand
Abbreviated Injury Scale
Abdominal Injuries
Equipment and Supplies
Injury Severity Score
Trauma Centers
Incidence
Peritonitis
Intensive Care Units
Registries
Inpatients
Sepsis
Confidence Intervals

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Stapled versus sutured gastrointestinal anastomoses in the trauma patient. / Brundage, Susan I.; Jurkovich, Gregory; Grossman, David C.; Tong, Wai Chung; Mack, Chris D.; Maier, Ronald V.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 47, No. 3, 01.09.1999, p. 500-508.

Research output: Contribution to journalArticle

Brundage, Susan I. ; Jurkovich, Gregory ; Grossman, David C. ; Tong, Wai Chung ; Mack, Chris D. ; Maier, Ronald V. / Stapled versus sutured gastrointestinal anastomoses in the trauma patient. In: Journal of Trauma - Injury, Infection and Critical Care. 1999 ; Vol. 47, No. 3. pp. 500-508.
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AU - Maier, Ronald V.

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N2 - Background: Construction of gastrointestinal anastomoses by using stapling devices has become a familiar procedure. Most studies have shown no significant differences in complication rates between stapled and sutured anastomoses performed during elective surgery. To date, no study has evaluated the incidence of complications of stapled anastomoses in the trauma patient. The purpose of our study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses after the emergent repair of traumatic bowel injuries. Methods: A retrospective analysis of the medical and institutional trauma registry records of patients identified to have undergone a gastrointestinal anastomosis in a regional Level I trauma center over a 4-year period. Results: A total of 84 patients with 118 gastrointestinal anastomoses were identified. A surgical stapling device was used to create 58 separate anastomoses, whereas a hand-sutured method was used in 60 anastomoses. A complication was defined as an anastomotic leak verified at reoperation. The ratio of blunt versus penetrating injuries, mean abdominal Abbreviated Injury Scale score, and Injury Severity Score were similar in the two groups. Stapling and suturing techniques were evenly distributed between small and large bowel repairs. Mean intensive care unit length of stay was comparable in both cohorts. However, inpatient length of stay was longer in patients with solely a stapled anastomosis compared with sutured anastomoses. Four of the 58 stapled anastomoses and none of the 60 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (relative risk = undefined; 95% confidence interval, 1.14-infinity; p = 0.037). Each anastomotic leak occurred in a separate individual. The only death occurred in the stapled cohort secondary to peritonitis and subsequent sepsis. Conclusion: Anastomotic leaks seem to be associated with stapled bowel repairs compared with sutured anastomoses in the traumatically injured patient.

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