There are always new horizons of technology. One is transition from open to laparoscopic surgery and another is stapler anastomosis over manual anastomosis. But cost factor, availability and learning curves all affect our choices. So stapler anastomosis is better or preferred over manual anastomosis?
Stapler anastomosis has adventeges for low anterior resection, but manual is superior for intrasphincteric resection with coloanal anastomosis .
Stapler anastomosis is definitely better than handsewn in colorectal surgery and is highly beneficial in fast track approaches but one should avoid it in presence of acute obstruction and edema.Rectal cancer management has been revolutionised by stapler technology in modern surgery including laparoscopic approach.
Teaching the sutured technique is still best practice as stapler malfunction (usually operator) happens. Personally i still suture many anastomoses in open surgery and laparoscopic, except rectal anastomoses, but as the comment above, the ability to perform a handsewn coloanal or ileoanal seems a dying art!
Both stapler and manual anastomosis works well, the question is: where we decided to put the different anastomosis? The previous comment have had answered very well and unfolded the problem. I suggest, anyway, to do and to teach manual anastomosis to young surgeons.
I am not sure there is a difference. The 3 most important things a regarding anastamotic healing are blood supply, blood supply and blood supply. I staple all mine as its quick and clean and easy. However, I do take Ian Daniels' point about getting out of trouble in case of stapler malfunction - however, I find this occurs as bad luck would have it, at coloanal anastamoses, and then have to do a handsewn coloanal from below, not something I really want to teach trainees routinely.
It does not seem one technique to have significant benefits compared to another. Only for right colectomy for cancer stapled side-to side anastomosis showed marginally better results, however I personally never use it. You can look at two most recent systematic reviews on the subject:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3536859/pdf/WJGS-4-208.pdf
http://archsurg.jamanetwork.com/article.aspx?articleid=1654856
I agree with all the comments above. What is important is sufficient mobilisation to avoid tension in the anastomosis and ensuring good blood supply and thus viability of the bowel ends.
I agree with all the comments above. What is important is sufficient mobilisation to avoid tension in the anastomosis and ensuring good blood supply and thus viability of the bowel ends.
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