Stapled versus hand-sewn pediatric intestinal anastomoses: A retrospective cohort study☆
Section snippets
Materials and methods
A retrospective review of pediatric patients under 5 years of age undergoing an intra-abdominal intestinal anastomosis between 2012 and 2016 at a single large tertiary pediatric hospital was performed. Institutional ethics approval was obtained [#H16–01016]. Demographic data including gestational age at birth, gender, the presence of any congenital anomalies, underlying surgical diagnosis, age and weight at procedure, and the length of follow-up was collected. Characteristics of the anastomosis
Results
Over the four years reviewed, a total of 90 intestinal anastomoses were performed in 72 patients. 67 were hand-sewn, and 23 were stapled (Table 1). Both age and weight at the time of surgery were comparable between the anastomotic groups. In the HS group, the median age at the time of operation was 8.9 months, while it was 10.5 months in the SA group (p = 0.629). In the HS group, median weight was 8 kg, while it was 8.2 kg in the SA group (p = 0.848). A significant difference between anastomotic groups
Discussion
Stapled intestinal anastomoses have been widely studied in the adult population, and thus their safety and efficacy when compared to hand-sewn anastomoses is un-questioned [1], [2], [3]. In fact, there is evidence to suggest that, besides a decrease in operative time, a decreased rate of anastomotic leak may be seen in ileocolic anastomoses specifically, with the use of a stapled technique [4]. In children however, the evidence base is not nearly as strong. Despite stapling devices being first
Conclusions
We present, to our knowledge, one of the largest reported pediatric studies comparing outcomes of hand-sewn and stapled intestinal anastomoses, and we found no significant differences in anastomotic outcomes between the two groups. This suggests that, when permitted by intestinal size, a stapled anastomosis is a safe choice. Ultimately, as already carried out in the adult population, a prospective, multi-centre trial would be most helpful in comparing stapled to hand-sewn anastomotic techniques
Acknowledgements
Ms. Maryam Noparast for assistance with statistical analysis.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.