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A COMPARATIVE STUDY ON THE OUTCOME OF STAPLER ANASTOMOSIS VS. HAND-SEWN ANASTOMOSIS IN ELECTIVE GASTROINTESTINAL SURGERIES.

BACKGROUND

The restoration of intestinal continuity after removal of a pathological lesion affecting the bowel, by joining the two ends is called as anastomosis. Numerous surgical conditions require the resection of bowel segments and the creation of reliable anastomosis. As such, anastomotic techniques have been central to the development of modern surgical practice. Back in 1000 BC, Sushrutha "Father of Indian Surgery" described the use of black ants for the intestinal suturing. [1] Later in 18th century Lembert and Halsted established the basic principles and different methods of intestinal suturing. [2,3] The most important aspect to create a healthy and tension-free anastomosis is to form a good opposition of the bowel edges in presence of excellent blood supply. [4]

Gastrointestinal anastomosis can be done either by handsewn technique or using mechanical stapling devices. Handsewn anastomosis in which absorbable and non-absorbable suture materials are used to create an anastomosis is worldwide established and accepted by the surgeons since 19th century. [5] Mechanical stapling devices which came to use around early 1910's was not successful and accepted by the surgeons in the beginning due to mechanical difficulties and non-reliability. [6] But the evolution of the mechanical surgical stapling devices to create gastrointestinal anastomosis has become a real technological advancement in the field of surgery and has been widely used with ease by the surgeons nowadays.

Many surgeons now consider stapling technique as a better alternate to conventional hand-sewn technique for speed, safety, efficacy and accessibility. Presently, surgical staplers play a major role in major gastro-intestinal surgeries. Anastomotic dehiscence and leak are the 2 most important and deadly complications of GIS. If following basic surgical principles such as meticulous technique with avoidance of tension at the site of anastomosis, maintaining optimal tissue vascularity, avoidance of associated systemic illnesses, proper perioperative nutritional optimization, proper perioperative control of medical comorbidities, one can create a safe and reliable anastomosis. The rate of stricture at the anastomotic site is considerably higher with stapled anastomosis than with hand-sewn anastomosis.

Previous individual trials made to compare between the conventional hand-sewn technique and stapler anastomosis have not shown either of the technique superior to the other. [7][8][9] Most recent studies done specifically to compare between the hand-sewn anastomosis versus stapled anastomosis in elective gastrointestinal surgeries were lacking adequate information on outcome assessment. The aim of this study is to compare the above-mentioned parameters between the conventional hand-sewn anastomosis versus stapled anastomosis in elective gastrointestinal surgeries.

MATERIALS AND METHODS

This prospective non-randomised interventional study included 50 patients who are admitted in surgical wards of SRM Medical College Hospital and Research Centre, Kancheepuram District, Tamilnadu, requiring elective gastrointestinal surgeries. A complete detailed history and physical examination was done. Data collection was done from March 2016 to August 2017. This study included male or female subjects (between the ages of 18 to 80 years) undergoing elective surgery requiring a gastric, small or large bowel anastomosis. As all the patients who met the inclusion criteria between March 2016 and August 2017 were planned to include in the study, sample size calculation was not done.

Exclusion criteria for this study were patients less than 18 years, gastrointestinal anastomosis done in emergency setting, biliary-enteric anastomosis, patients refused to give the consent, patients with prior chemo-radiation, patients with severe systemic illness and pregnant women.

The study was started after obtaining ethical committee clearance. A well-explained informed and written consent was also obtained from the patient. Patients were divided into four groups based on the site of anastomosis. Out of 50 patients 6 total gastrectomy, 22 subtotal gastrectomy, 14 right hemicolectomy and 8 anterior resection were performed. Patients were allocated into hand-sewn group and stapler group alternatively. In each group, one-half was operated with hand-sewn technique and other half with stapled technique for GI anastomosis. The hand-sewn anastomosis method included cases with at least one bowel anastomosis without the use of staplers. The stapler anastomosis method included cases with at least one bowel anastomosis done with a stapler. It also includes cases with multiple bowel anastomosis done with both hand-sewing and stapler.

In total gastrectomy group, post total gastric resection, end-to-end oesophagojejunostomy with side-to-side jejunojejunostomy was done by stapler or hand-sewn technique. In subtotal gastrectomy group (Gastrojejunostomy), after subtotal resection of stomach, end-to-side gastrojejunostomy was done with stapler or hand-sewn method. In right hemicolectomy group (ileotransverse anastomosis), approximately 10 cm of terminal ileum, caecum along with appendix, ascending colon and one-third of the proximal transverse colon was resected and side-to-side anastomosis was done using hand-sewn or stapler method. In anterior resection group (colorectal anastomosis), after the resection of the pathology involving rectosigmoid region, end-to-end colorectal anastomosis is done either by hand suturing or staplers. Hand-sewn anastomosis was done in either single layer or double layer anastomosis using 2-0/ 3-0 Vicryl (polyglactin) and 3-0 silk for the outer seromuscular layer. Linear cutting staplers (TLC 55, TLC 75), Linear anastomosing staplers (TCR 55, TCR 75), Circular anastomosing staplers (CDH 25, CDH 29) were used based on the need in stapler anastomosis.

Operational Definitions

Duration of anastomosis was counted from resection of the specimen till the end of anastomosis. Duration of surgery was counted from start of skin incision till skin closure. Return of bowel activity was assessed by return of bowel sounds postoperatively. Resumption of oral feeds included the number of days taken to start oral feeds postoperatively. Acute postoperative complications assessed anastomotic leak and wound infection. Anastomotic leak was assessed by appearance of gastric or intestinal contents through the drain. Wound infection was assessed by purulent discharge from the skin incision site.

Statistical analysis was performed using Statistical Package for Social Science (SPSS, version 17) for Microsoft Windows. Since data was not normally distributed, nonparametric tests (Mann-Whitney test) were performed. Descriptive statistics were presented as numbers and percentages. The data were expressed as Mean and SD. Mann-Whitney test were used to compare continuous variables between two groups. A chi-squared test was used for comparison between percentages. A two-sided p-value < 0.05 was considered statistically significant.

RESULTS

Out of 50 patients 6 total gastrectomy, 22 subtotal gastrectomy, 14 right hemicolectomy and 8 anterior resection were performed. Each group has two subgroups (A) and (B), in which (A) belongs to hand-sewn anastomosis group and (B) belongs to stapled anastomosis group. Group 1: Total Gastrectomy. Group 1A: Hand-sewn anastomosis--3 cases. Group 1B: Stapler anastomosis--3 cases.

Majority of the patients, 66.7% are males in hand-sewn group and 100% in stapler group. The mean age of patients in hand-sewn group is 52 years and mean age of patients in stapler group is 57.3 years. Mean duration taken for oesophagojejunostomy in hand-sewn group is 32 mins and in stapler group is 25 mins. Mean duration taken for jejunostomy-jejunostomy in hand-sewn group is 27 mins and in stapler group is 23 mins. The mean time taken for total gastrectomy in hand-sewn group is 178.67 mins and in stapler group is 165.67 mins. The average number of days taken for return of bowel sounds in hand-sewn group is 5.67 days and in stapler group is 3.67 days. Average number of days taken to start oral feeds in hand-sewn group is 6.33 days and in stapler group is 4 days. Average number of postoperative hospital days of patients in hand-sewn is 15.33 days and in stapler group is 13.33 days. There is no significant difference in age, duration of anastomosis, duration of surgery, return of bowel activity, oral feed starting day, post-operative hospital stay with the p-value >0.05 (Mann-Whitney test).

Early Postoperative Complications

One patient (33.3%) from hand-sewn group developed wound infection postoperatively and no patients from stapler group had early postoperative complications. This difference was not significant (p > 0.05) (Figure 1) (Chi-square test).

Group 2: Subtotal Gastrectomy (Gastro-Jejunostomy) Group 2A: Hand-sewn anastomosis- 11 cases. Group 2B: Stapler anastomosis- 11 cases.

Majority of the patients, 72.7% are males in hand-sewn group and 81.8% are males in stapler group. The mean age of patients in hand-sewn group is 60.45 years and mean age of patients in stapler group is 55.82 years. Mean duration taken for gastro-jejunostomy in hand-sewn group is 31.09 mins and in stapler group is 22 mins. The mean time taken for total gastrectomy in hand-sewn group is 186.27 mins and in stapler group is 156.55 mins. The average number of days taken for return of bowel sounds in hand-sewn group is 5.91 days and in stapler group is 4.09 days. Average number of days taken to start oral feeds in hand-sewn group is 6.36 days and in stapler group is 4.82 days. Average number of postoperative hospital days of patients in hand-sewn is 15.55 days and in stapler group is 13.55 days. There is a significant difference in duration of anastomosis, duration of surgery, return of bowel activity, oral feed starting day, postoperative hospital stay (Table 2) (Mann-Whitney test).

Early Postoperative Complications

Two patients (18.2%) from hand-sewn group and one patient (9.1%) from stapler group developed wound infection postoperatively. One patient from hand-sewn group developed anastomotic leak. No significant difference in early postoperative complications between hand-sewn group and stapler group (p > 0.05) (Figure 2) (Chi-square test).

Group 3: Right hemicolectomy group (Ileotransverse anastomosis).

Group 3A: Hand-sewn anastomosis- 7 patients. Group 3B: Stapler anastomosis- 7 patients.

Among 7 patients, 5 (71.4%) are males and 2 patients (28.6%) are females in both hand-sewn group and stapler group.

The mean age of patients in hand-sewn group is 48.14 years and mean age of patients in stapler group is 39.57 years. Mean duration taken for ileo-transverse anastomosis in hand-sewn group is 35.86 mins and in stapler group is 25.71 mins. The mean time taken for right hemicolectomy in hand-sewn group is 180.14 mins and in stapler group is 147.71 mins. The average number of days taken for return of bowel sounds in hand-sewn group is 5.71 days and in stapler group is 3.86 days. Average number of days taken to start oral feeds in hand-sewn group is 6.43 days and in stapler group is 4.43 days. Average number of postoperative hospital days of patients in hand-sewn is 15.29 days and in stapler group is 11.86 days. There is a significant difference in duration of anastomosis, duration of surgery, return of bowel activity, oral feed starting day, postoperative hospital stay between Group A and B with p-value > 0.05 (Mann-Whitney test) (Table 3)

Early postoperative complications in right hemicolectomy group. Two patients (28.6%) from hand-sewn (3A) group developed wound infection postoperatively respectively and none from stapler group (Figure 3) (p > 0.05) (Chi-square test).

Group 4: Anterior Resection (Colorectal anastomosis) Group 4A: Hand-sewn anastomosis- 4 patients. Group 4B: Stapler anastomosis- 4 patients.

Among 4, three patients (75%) are males and one (25%) female in hand-sewn group. All 4 (100%) patients in stapler group are males. The mean age of patients in hand-sewn group is 52.75 years and mean age of patients in stapler group is 66.75 years. Mean duration taken for colorectal anastomosis in hand-sewn group is 33.75 mins and in stapler group is 28.75 mins. The mean time taken for anterior resection in hand-sewn group is 212.75 mins and in stapler group is 187 mins. The average number of days taken for return of bowel sounds in hand-sewn group is 5.5 days and in stapler group is 3.5 days. Average number of days taken to start oral feeds in hand-sewn group is 6.23 days and in stapler group is 4.5 days. Average number of post-operative hospital days of patients in hand-sewn group is 15 days and in stapler group is 13.75 days. As per Mann-Whitney test, there is a significant difference in duration of anastomosis, duration of surgery, return of bowel activity, oral feed starting day, post-operative hospital stay (Table 4).

Early Postoperative Complications

One patient (25%) from stapler group (4B) developed wound infection postoperatively and none from stapler group (p>0.05) (Figure 4) (Chi-square test).

DISCUSSION

A comparative study between hand-sewn and stapler anastomosis in elective gastrointestinal surgeries in 50 patients was done and the results obtained were analysed and compared with previously done and published studies.

In our study, we found statistically significant reduction in anastomotic time in stapled group than hand-sewn group in oesophagojejunostomy and jejunojejunostomy, gastrojejunostomy, ileocolic anastomosis and colorectal anastomosis with p-value < 0.05. Similar results were seen in a study done by Subhakar Bhandary et al [7] in 2016.

Scher et al [10] study revealed insignificant difference in total operating time between hand-sewn and stapled method in gastric surgeries. Reiling et al [11] too reported the same. Contrary to these studies, we found statistically significant reduction in total operating time in stapled group than handsewn group in total gastrectomy, subtotal gastrectomy, right hemicolectomy and anterior resection with p-value < 0.05.

Previously done studies by PB Nichkaode et al (2013), [12] Luechakiettisak P et al (2008)[13] and Hsu HH et al (2004)[14] comparing oesophageal surgeries between handsewn and stapled method reported that total operating time was lesser in stapled group compared to hand-sewn group.

We found mean total operating time for subtotal gastrectomy with gastrojejunostomy was lesser in stapled anastomosis when compared to hand-sewn anastomosis group. Similar results were seen in previous studies done by Hollender et al [15] and George et al. [16]

Scher et al [10] and Reiling et al [11] described insignificant difference in total operating time in right hemicolectomy between stapler and hand-sewn anastomosis. In our study we found statistically significant difference between two groups with stapled anastomosis group being shorter duration than hand-sewn group.

Adloff et al [17] in his study on colorectal surgeries reported that there is no significant difference in operating time of colorectal surgeries between stapler and hand-sewn anastomosis. In our study we found statistically significant shorter total operating time for colorectal surgeries in stapled group than hand-sewn group with p-value < 0.05. This was parallel to the previous studies done by PB Nichkaode et al [12] and Beuran et al. [18]

PB Nichkaode et al [12] and Damesha N et al [19] in their studies reported early return of bowel activity in oesophageal surgeries done by stapler anastomosis than hand-sewn anastomosis. Our study results were found similar with statistically significant p-value < 0.05.

In gastrojejunostomy group, we found early return of bowel activity in stapled group than hand-sewn group with statistically significant p-value < 0.05. Similar results were seen in studies conducted by PB Nichkaode et al [12] and Damesha N et al. [19]

Scher et al [10] reported there was no significant difference in return of bowel activity between hand-sewn and stapled group in ileocolic surgeries. In our study, we found statistically significant early return of bowel activity in stapled group than in hand-sewn group among right hemicolectomy surgeries which runs parallel with results of study by Damesha N et al. [19]

PB Nichkaode et al [12] reported there was significant early return of bowel activity between hand-sewn and stapled group in colorectal surgeries. Similarly, in our study we found statistically significant early return of bowel activity in stapled group than in hand-sewn group. This contrary to results from study done by Damesha N et al. [19]

We found statistically significant early resumption of oral feeds in stapled group than hand-sewn group in all four surgeries. Similar results were found in study done by Damesha N et al [19] for gastrojejunostomy and anterior resection. In right hemicolectomy no significant difference in resumption of oral feeds were reported in Damesha N et al [19] and Scher et al. [10]

We found there was significant reduction in postoperative hospital stay in stapled oesophagojejunostomy group than hand-sewn group. This is contrary to previous studies done by PB Nichkaode et al [12] and Craig SR et al (1996). [20] Seo SH et al (2012)[21] and Damesha N et al [19] reported no significant difference in postoperative hospital stay between hand-sewn and stapled group. In our study, we found significant reduction in postoperative stay in stapled group than hand-sewn group with p-value < 0.05. This is similar with the results seen in study done by PB Nichkaode et al. [12] In our study, stapled right hemicolectomy led to lesser postoperative hospital days than hand-sewn group. This was found contrary to the results from studies done by Damesha N et al, [19] Scher et al [10] and Reiling et al [11] where insignificant difference was seen between both groups. Previous studies done by Himabindu Bangaru et al, [22] Finger et al [23] and Damesha N et al [19] showed insignificant difference in postoperative hospital days between hand-sewn and stapled colorectal surgeries. Similarly, in our anterior resection group, the post-operative hospital stay was insignificant with p-value > 0.05 between stapled and handsewn group.

Out of 11 hand-sewn subtotal gastrectomy with gastrojejunostomy, one patient developed anastomotic leak which was treated conservatively. None of the patients had anastomotic leak in stapled group. PB Nichkaode et al [12] and Seo S et al [21] also described the insignificance of anastomotic leak between two groups. None of the patients from total gastrectomy, right hemicolectomy and anterior resection had anastomotic leak postoperatively. This shows there is no significance between stapled and hand-sewn method in terms of anastomotic leak.

Previous studies done by Saluja SS et al [24] showed the insignificant difference in oesophageal anastomosis. Insignificance in colorectal surgery was described by studies done by Nasirkhan et al. [25] Damesha N et al report insignificant difference in anastomotic leak seen in right hemicolectomy surgeries between stapled and hand-sewn anastomosis. Two out of 25 patients from stapled group and 5 out of 25 from hand-sewn group had skin wound infection which was insignificant statistically and treated conservatively. No mortality among the study group.

The limitation of this study was small sample size. Results with higher sample size may vary or show different results.

CONCLUSION

Due to shortened operating time, staplers are favourable for patients with poor general condition who would not tolerate prolonged anaesthesia. The insignificant difference in acute postoperative complications suggests both hand-sewn and stapled method can be done with same safety and accuracy when done with proper technique.

REFERENCES

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[2] Lembert A. Memoire sur l'enterorraphie avec description d'un precede nouveau pour pratiquercette operation chirurgicale. Rep Gen D'Anat Physiol Pathol Clin Chir 1826;2:100-7.

[3] Halsted WS. Circular structure of the intestine: an experimental study. Am J Med Sci 1887;94:436-61.

[4] Kirk RM, Winslet M. Essential general surgical operations. Edinburgh: Churchill Livingstone 2001.

[5] Senn N. Enterorrhaphy, its history, technique and present status. JAMA 1893;21:215-35.

[6] Britton J. Intestinal Anastomosis. In: Souba WW, Fink MP, Jurkovich GJ, et al. ACS Surgery principles and practices. 6th edn. New York: Web MD Professional Publishing 2007: p. 870-81.

[7] Bhandary S, Babu NM, Gojanur G, et al. Comparative study of bowel anastomosis--Hand sewn versus stapler. IOSR Journal of Dental and Medical Sciences 2016;15(12):37-42.

[8] Chandramohan SM, Gajbhiye RN, Agarwal A, et al. A randomized study comparing outcomes of stapled and hand-sutured anastomoses in patients undergoing open gastrointestinal surgery. Indian J Surg 2013;75(4):311-16.

[9] Khan AQ, Awan N, Dar WR, et al. Surgical outcome of stapled and hand sewn anastomosis in lower gastrointestinal malignancies: a prospective study. Arch Int Surg 2016;6(1):1-6.

[10] Scher KS, Scott-Conner C, Ong WT. A comparison of stapled and sutured anastomoses in gastric operations. Surg Gynecol Obstet 1982;154(4):548-52.

[11] Reiling RB, Reiling WA, Bernie WA, et al. Prospective controlled study of gastrointestinal stapled anastomoses. Am J Surg 1980;139(1):147-52.

[12] Nichkaode PB, Kulshrestha M, Akhtar MA, et al. Comparative study of stapler anastomosis over hand sewn anastomosis in elective gastrointestinal surgeries. Journal of Evolution of Medical and Dental Sciences 2013;2(19):3408-15.

[13] Luechakiettisak P, Kasetsunthorn S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study. J Med Assoc Thai 2008;91(5):681-5.

[14] Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothoracic Surg 2004;25(6):1097-101.

[15] Hollender LF, Blanchot P, Meyer C, et al. Mechanical suturing apparatus in gastro-intestinal surgery. Zentralbl Chir 1981;106(2):74-83.

[16] George WD. Suturing or stapling in gastrointestinal surgery: a prospective randomized study. West of Scotland and Highland Anastomosis Study Group. Br J Surg 1991;78(3):337-41.

[17] Adloff M, Arnaud JP, Beehary S. Stapled versus sutured colorectal anastomosis. Arch Surg 1980;115(12):1436-8.

[18] Beuran M, Chiotoroiu AL, Chilie A, et al. Stapled vs. hand-sewn colorectal anastomosis in complicated colorectal cancer--a retrospective study. Chirurgia (Bucur) 2010;105(5):645-51.

[19] Damesha N, Lubana PS, Jain DK, et al. A comparative study of sutured and stapled anastomosis in gastrointestinal operations. Int J Surg 2008;15(2):1-6.

[20] Craig SR, Walker WS, Cameron EW, et al. A prospective randomized study comparing stapled with handsewn esophagogastric anastomoses. J R Coll Surg Edinb 1996;41(1):17-9.

[21] Seo SH, Kim KH, Kim MC, et al. Comparative study of hand sutured versus circular stapled anastomosis for gastrojejunostomy in laparoscopy assisted distal gastrectomy. J Gastric Cancer 2012;12(2):120-5.

[22] Bangaru H, Veitla RMR, Pigilam M, et al. Comparative study between staplers and conventional (hand-sewn) anastomosis in gastrointestinal surgery. Indian J Surg 2012;74(6):462-7.

[23] Fingerhut A, Hay JM, Elhadad A, et al. Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples--a controlled clinical trial. French Associations for Surgical Research. Surgery 1995;118(3):479-85.

[24] Saluja SS, Ray S, Pal S, et al. Randomized trial comparing side-to-side stapled and hand sewn esophagogastric anastomosis in neck. J Gastrointest Surg 2012;16(7):1287-95.

[25] Nasirkhan MU, Abir F, Longo W, et al. Anastomotic disruption after large bowel resection. World J Gastroenterology 2006;12(16):2497-504.

R. Lakshmana (1), R. Sivamarieswaran (2), Athira Gopinathan (3)

(1) Assistant Professor, Department of General Surgery, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamilnadu. (2) Postgraduate Student, Department of General Surgery, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamilnadu. (3) Senior Resident, Department of General Surgery, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamilnadu.

'Financial or Other Competing Interest': None.

Submission 19-04-2018, Peer Review 01-05-2018, Acceptance 03-05-2018, Published 07-05-2018.

Corresponding Author:

Dr. Gopinathan Athira, S-1, Plot No. 247, Abhi's Aradhana, E-Block, Parvathy Nagar South, 3rd Cross Street, Madambakkam, Chennai-600126, Tamilnadu.

E-mail: drathirag@gmail.com

DOI: 10.14260/jemds/2018/519
Table 1. Comparison between Hand-Sewn Anastomosis and Stapler
Anastomosis in Total Gastrectomy Cases

Variable            Group      Mean      Std.      P value
                                       Deviation

Age                Group 1a   52.00     13.748       0.7
                   Group 1b   57.33      6.658

OJ (Duration of    Group 1a   32.00      2.000       0.1
anastomosis)       Group 1b   25.00      1.000

JJ (Duration of    Group 1a   27.00      1.000       0.1
anastomosis)       Group 1b   23.00      1.000

Duration of        Group 1a   178.67     3.055       0.1
surgery            Group 1b   165.67     4.041

Return of bowel    Group 1a    5.67      .577        0.1
activity           Group 1b    3.67      .577

Oral feeding       Group 1a    6.33      .577        0.1
starting day       Group 1b    4.00      .000

No. of hospital    Group 1a   15.33      .577        0.1
days               Group 1b   13.33      .577

Table 2. Comparison between Hand-Sewn Anastomosis and
Stapler Anastomosis in Subtotal Gastrectomy Cases

Variable           Group      Mean      Std.      P value
                                      Deviation

Age               Group 2A   60.45     10.073      0.261
                  Group 2B   55.82      8.670

OJ (Duration of   Group 2A   31.09      1.921      0.000
anastomosis)      Group 2B   22.00      1.612

JJ (Duration of   Group 2A   186.27     6.198      0.000
anastomosis)      Group 2B   156.55     3.588

Duration of       Group 2A    5.91      .302       0.000
surgery           Group 2B    4.09      .302

Return of         Group 2A    6.36      .505       0.000
bowel activity    Group 2B    4.82      .603

Oral feeding      Group 2A   15.55      .522       0.000
starting day      Group 2B   13.55      .820

Table 3. Comparison between Hand-Sewn Anastomosis and Stapler
Anastomosis in Right Hemicolectomy Group

Variable            Group      Mean      Std.      P value
                                       Deviation

Age                Group 3A   48.14     19.895      0.805
                   Group 3B   39.57     10.690

Ileotransverse     Group 3A   35.86      1.952      0.001
anastomosis time   Group 3B   25.71      .756

Time taken for     Group 3A   180.14     7.221      0.001
hemicolectomy      Group 3B   147.71     1.890

Return of bowel    Group 3A    5.71      .488       0.001
activity           Group 3B    3.86      .378

Oral feeding       Group 3A    6.43      .535       0.001
starting day       Group 3B    4.43      .535

Duration of        Group 3A   15.29      .951       0.001
postoperative      Group 3B   11.86      .900
stay

Table 4. Comparison between Hand-Sewn Anastomosis and Stapler
Anastomosis in Right Hemicolectomy Group in Anterior Resection Patients

Variable           Group      Mean      Std.      P value
                                      Deviation

Age               Group 4A   52.75     14.361      0.20
                  Group 4B   66.75     12.606
Colorectal        Group 4A   33.75      1.708      0.029
anastomosis       Group 4B   28.75      .957
time
Anterior          Group 4A   212.75     5.737      0.029
resection time    Group 4B   187.00     2.582

Return of bowel   Group 4A    5.50      .577       0.029
activity          Group 4B    3.50      .577

Oral feeding      Group 4A    6.25      .500       0.029
starting day      Group 4B    4.50      .577

Duration of       Group 4A   15.00      .816       0.114
postoperative     Group 4B   13.75      .957
stay

Figure 1. Acute Postoperative Complications Hand-Sewn
Anastomosis and Stapler Anastomosis in Total
Gastrectomy Cases

Acute postoperartive complications

           WOUND INFECTION   NIL

GROUP 1A         33.3        66.7
GROUP 1B            0         100

Note: Table made from bar graph.

Figure 2. Comparison of Acute Postop Complications
between Hand-Sewn and Stapler Group

EARLY POST OP COMPLICATIONS

            WOUND INFECTION    ANASTOMOTIC LEAK     NIL

GROUP 2A         18.2               9.1            72.7
GROUP 2A          9.1                 0            90.9

Note: Table made from bar graph.

Figure 3. Comparison of Acute Postop Complications
between Hand-Sewn and Stapler Group in Hemicolectomy
Patients

EARLY POST OPERATIVE COMPLICATIONS

           WOUND INFECTION    ANASTOMOTIC LEAK   NIL

GROUP 3A         28.6                0           71.4
GROUP 3B          0                  0           100

Note: Table made from bar graph.

Figure 4. Comparison of Acute Postop Complications
between Hand-Sewn and Stapler Group in Anterior
Resection Cases

POST OPERATIVE COMPLICATIONS

          WOUND INFECTION    ANASTOMOTIC LEAK   NIL

GROUP 3A          0                  0           100
GROUP 3B          25                 0           75

Note: Table made from bar graph.
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Title Annotation:Original Research Article
Author:Lakshmana, R.; Sivamarieswaran, R.; Gopinathan, Athira
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:May 7, 2018
Words:4452
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