Emergency Surgery Department "A. Cardarelli" Hospital, Naples Italy.
Emergency Surgery Department "A. Cardarelli" Hospital, Naples Italy.
J Surg Res. 2023 Jan;281:52-56. doi: 10.1016/j.jss.2022.08.007. Epub 2022 Sep 15.
Although stapled anastomoses have been widely evaluated in the context of the elective surgery, few reports compared manual with stapled anastomoses in patients undergoing emergency surgery. The aim of this study is to compare the outcome of hand-sewn end-to-end anastomoses with stapled side-to-side and stapled end-to-side anastomoses in patients undergoing small bowel resection for acute mesenteric ischemia secondary to intestinal obstruction.
From January 2015 to June 2021 all the hemodynamically stable patients undergoing emergency surgery with small bowel resection for intestinal obstruction were enrolled in this study. According to surgical technique in performing anastomosis, the patients were divided into three groups: group 1: hand-sewn end-to-end anastomosis, group 2: stapled end-to-side anastomosis, and group 3: stapled side-to-side anastomosis.
Although the anastomosis failure rate was higher in group 3, it was not significantly different between the three groups (P = 0.78: chi-square test). Likewise, no significant differences in the median hospital stay were found between the patients' groups (P = 0.87: Kruskal-Wallis test). The median operating time was similar in patients undergoing stapled anastomoses and was significantly higher in patients undergoing hand-sewn anastomoses (P = 0.0009: Kruskal-Wallis test).
In patients undergoing emergency small bowel resection for complicated intestinal obstruction, a similar outcome in terms of dehiscence rate and hospital stay can be achieved performing stapled or hand-sewn anastomoses, even if restoring the intestinal continuity with stapled technique is associated with lower operating time.
虽然吻合器吻合术在择期手术中已得到广泛评估，但很少有研究报告比较急症手术中手工吻合与吻合器吻合的效果。本研究旨在比较在因肠梗阻导致的急性肠系膜缺血而行小肠切除术的患者中，手工端端吻合与吻合器端侧吻合和侧侧吻合的结果。
从 2015 年 1 月至 2021 年 6 月，所有血流动力学稳定且因肠梗阻而行急症手术的患者均被纳入本研究。根据吻合术式，将患者分为三组：组 1：手工端端吻合，组 2：吻合器端端吻合，组 3：吻合器侧侧吻合。
尽管第 3 组吻合失败率较高，但三组之间差异无统计学意义（P=0.78：卡方检验）。同样，三组患者的中位住院时间无显著差异（P=0.87：Kruskal-Wallis 检验）。接受吻合器吻合的患者手术时间中位数相似，而接受手工吻合的患者手术时间显著更长（P=0.0009：Kruskal-Wallis 检验）。
在因复杂肠梗阻而行急症小肠切除的患者中，采用吻合器或手工吻合均可获得相似的吻合口裂开率和住院时间，尽管采用吻合器技术恢复肠连续性与更低的手术时间相关。
