A Comparative study on Outcome of Stapler Versus Hand Sewn Anastamosis in Elective Gastro Intestinal Surgeries

Sadasivam, S (2013) A Comparative study on Outcome of Stapler Versus Hand Sewn Anastamosis in Elective Gastro Intestinal Surgeries. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: In gastro intestinal surgery after rection of bowel loops, anastomosis of the bowel loops is the central part of the gastroentrology. Sero muscular suture technique is the main stay of the Gastro intestinal surgery which is described lembert in 1826. Single layer extra mucosal anastomosis is the more commonly used now a days which is described by Matheson of Aberdeen because of which has the capacity to produced least tissue necrosing or luminal narrowing. Which has to replaced to catgut and silk now a days The stapler devices recently introduced and this helps anastomosis of bowel loops with less tissue injury and ased time duration of procedure. It also decreases the anastamotic leak complication. For the past years stapler technique commonly used many of the surgeons, its more useful than the hand sewn anastomosis for safety, easily accessibility, duration of procedure, efficiency. This study compares the hand sewn anastomosis with stapler anastomosis and it conducted in our Govt. Stanley Hospital. So stapler technique is commonly used in many surgical deparment and widely accepted. Many surgeon having doubt regarding the stapler, how its used in critical sites, regarding 100% water with air anastomosis. Hand sewn statics made over stapled anastomosis it will protect the anastomotic site. AIM OF THE STUDY: The purpose of the presentation is to compare the feasibility safety and efficacy of the outcome of stapler and hand sewn anastomosis in elective gastro intestinal surgeries. MATERIALS AND METHODS: This study was conducted in the department of surgery & Department of gastroenterology at Govt. Stanley medical college, started from December 2011 to November 2012 between the groups of hand sewn and stapler anastomosis in elective gastro intestinal surgeries. • Control group- hand sewn anastomosis, • Study group-stapler anastomosis. This study included 100 patients; 56 of them underwent hand sewn anastomosis. Its consists of 37 male patients, 19 female patient (mean age group 51 years). 44 of them underwent stapler technique. Out of 44 patient 27 male patient,17female patient(mean age group 49 years). Hand sewn anastomosis done by single layer or double layer is under control group, but the study group has stapler anastomosis. Which was done by side to side or end to end anastomoses, it depends upon accessibility, the need of surgery, anastomotic site, using which type of stapler instruments. RESULTS: The mean age of this procedure 52 in hand sewn, 50 in stapler total number of patient was19 where 10 underwent hand sewn anastomosis, 9 underwent stapler anastomosis. In my study the average time of operation in hand sewn anastomoses is 2.400 hrs but in case stapler anastomoses it was 2.167 hrs. The return of bowel sound is 2.80 days in suture anastomosis, it was 2.22 in mechanical devices. The mean time of starting oral feeding is 3.20 days in hand sewn anastomoses but in case of stapler anastomoses it was 2.56 days .hospitalization is 8.10 days in hand sewn anastomoses, but it was 6.44 days stapler anastomoses. Average return to work in hand sewn technique is 5.60 month in contrast 4.22 month in stapler technique the p value of this 0..002. CONCLUSION: Comparison study of hand sewn versus stapler was conducted previously had not shown any different between these two anastomotic technique. In my study i found a significant difference in reduction of time duration of surgical procedure using well trained surgeons in both type ofanastomotic technique. Seven variability compare the six group gastro intestinal surgeries.The variability are following: • Duration of procedure, • Return of bowel sound, • Oral feeding, • Return to work, • Hospitalization, • Complication, • Mortality. So after conducting in my study the following results showing stapler anastomoses is superior to the hand sewn anastomoses: • Less tissue injury, • Less operating time, • Early recovery of bowel sound, • Oral feeding started as early as possible, • Early mobilization from the bed, • Decreased hospitalization, • Early return to normal day to day activity, Recent advanced mechanical are more costly than the suture materials, cost benefit not included in my study because the study done in Govt. hospital. The stapling techniques are quicker to perform, particularly in situations where inaccessibleeg pelvic surgeries like low colorectal anastomosis or in various oesophageal anastomosis. Thus, the staplinganastomosis can be used safely and effectively as part of the surgical department and one should be equally adept with a stapler gun as with needle-holder and suture.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Stapler, Hand Sewn Anastamosis, Elective Gastro Intestinal Surgerie, Comparative study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 03 Apr 2018 03:49
Last Modified: 13 Jan 2020 13:14
URI: http://repository-tnmgrmu.ac.in/id/eprint/6805

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