Stapled intestinal anastomosis is a simple and reliable method for management of intestinal caliber discrepancy in children

Kaori Sato, Hiroo Uchida, Yujiro Tanaka, Shinya Takazawa, Takahiro Jimbo, Kyoichi Deie, Kaori Sato, Hiroo Uchida, Yujiro Tanaka, Shinya Takazawa, Takahiro Jimbo, Kyoichi Deie

Abstract

Purpose: Popularity of minimally invasive surgeries has led to the development of stapled intestinal anastomosis for adults. The advanced instruments used in this technique are getting suitable with the small intestinal lumens of neonates and infants. We reviewed and compared the intraoperative and postoperative results of stapled and hand-sewn anastomoses in children.

Methods: The operative data of children who underwent stapled and hand-sewn anastomoses between March 2005 and December 2011 were collected and analyzed retrospectively. Furthermore, we compared patients who underwent anastomoses for colostomy closure of anorectal malformation (4 stapled, 9 hand-sewn) and those who underwent anastomoses for treatment of ileal atresia (3 stapled, 11 hand-sewn).

Results: In the 47 patients who underwent stapled anastomosis, no intraoperative complications were observed and postoperative complications included wound infection (n = 3), delayed gastric emptying (n = 1), and ileus (n = 1). No complications suggesting anastomotic dilatation were identified. It was observed that patients who underwent stapled anastomosis for colostomy takedown with caliber discrepancy had significantly shorter surgery time than those who underwent hand-sewn anastomosis.

Conclusion: Our results suggest that stapled anastomosis is safe and effective for various surgical diseases in neonates, infants, and children.

Figures

Fig. 1
Fig. 1
Functional end-to-end anastomosis. a 22Fr. soft catheter inserted in the intestinal tract of small diameter. b A side-to-side anastomosis is made in both limbs at the anti-mesenteric border. The staple lines are only oversewn at points of bleeding for hemostasis and for reinforcement of the crotch of side-to-side anastomosis (arrow). c The suture line of side-to-side anastomosis does not overlap when the stapler is fired across the jointed limbs. The staple lines are only oversewn at points of bleeding for hemostasis and for reinforcement of double-stapled areas (arrows)

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