A prospective comparative study between Staplers and Conventional Hand-sewn Anastomosis in Gastrointestinal Surgery

Prabakaran, A (2015) A prospective comparative study between Staplers and Conventional Hand-sewn Anastomosis in Gastrointestinal Surgery. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : For a proper and perfect gastrointestinal anastomosis , the factors to be considered are ‘ time required for surgery’, ‘restoration of normal GI function’, ‘effective hemostasis’, ‘reduction of tissue damage’, and ‘prevention of postoperative mortality and morbidity’; for example, anastomotic leak (sepsis). Fundamental for GI anastomosis whether, hand –sewn technique or stapling technique is, good approximation without tension and good blood supply . Staplers are capable of cutting and stapling at the same time and avoiding the need for clamping. The increased cost of the staplers is offset by reduction in operating time. Circular staplers have better access in difficult areas like lower Pelvic surgery, sparing many patients from permanent colostomy. Accordingly, it is worthwhile to study the GI anastomosis by using staplers or hand-sewn technique. AIM OF STUDY: To compare hand-sewn technique with surgical stapling technique in a prospective cohort study in patients undergoing elective gastrointestinal surgeries. Study Duration: 1 Year. Study Population: 100 Patients. MATERIALS AND METHODS: From our Prospective study from March 2014 to August 2014 in Chennai at Rajiv Gandhi Government General Hospital. A total of 100 patients were divided into 6 groups, depending on the surgery such as posterior gastrojejunostomy, anterior gastrojejunostomy, sub total gastrectomy and anterior gastrojejunostomy with jejunojeunostomy (Billroth II), ileostomy closure, colostomy closure, and hemicolectomy. Of 100 patients, 50 patients were hand-sewn group and the other 50 patients were in the stapler group which was grouped randomly by using lot. Inclusion Criteria: 1. Patients electively undergoing for bowel resection & anastomosis. 2. patients underwent diversion procedure in emergency situation, now requiring for stoma closure. 3. nutritionaly well-nourished patients those who hb%->10 gms, serum albumin -> 3 gms . Exclusion Criteria: 1. patients with indication of surgery other than mentioned in inclusion criteria. 2. associated surgeries & extended surgeries. 3. all emergency surgeries requiring bowel resection & anastomosis. 4. severe anemia & malnourished patients those were hb% - < 10 gms, serum albumin - < 3 gms. 5. advanced stage of malignancy in case of ca. stomach 7ca. rectum. CONCLUSION: Our study shows statistically significant reduction in operating time in staplers group compared with hand-sewn group. Other post operative parameters statistically not much significant. Also staplers has an advantage of approaching a difficult areas in hand-sewn group. Other advantages are for moribound patient it is time saving. The main disadvantage is cost and needs expertise in this procedure.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Staplers ; Conventional Hand-sewn Anastomosis ; Gastrointestinal Surgery ; prospective comparative study.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 22 Oct 2017 00:17
Last Modified: 22 Oct 2017 00:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/3790

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