Abstracts 1998 Digestive Disease Week
#1057
ARE STAPLED ANASTOMOSES IN GI SURGERY JUSTIFIED? K.A. GAWAD, J.R. IZBICKI, S.B. HOSCH, S. QUIRRENBACH, W.T. KNOEFEL, H.-U. KÜPPER*, C.E. BROELSCH. Department of Surgery, University of Hamburg and Institute of Controlling*, Universitiy of Munich, Germany.
Introduction: Limited financial resources require thoughtful expenditures even in socialised health care systems. Therefore a prospective randomized study was performed to evaluate the efficiency and cost effectiveness of hand sewn vs. stapled anastomoses in GI surgery.
Material and Methods: All patients with elective GI surgery (except Crohn's disease or ulcerative colitis) were elegible to be enrolled in the study. Patients were randomly allocated to either group only if both ways of reconstruction were applicable after resection. Patients were especially followed for anastomotic insufficiencies or strictures, postoperative bleeding and motility. The cost was calculated considering not only the suture material used but also the cost for the staff involved to perform a certain anastmoses or operation.
Results: A total of 324 anastomoses (170 stapled vs. 158 hand sewn) were performed during 200 operations in 200 Patients (80 female: 120 male) with a mean age of 60.2 (21-90) years. Of these operations 20.5% were gastrectomies, 14% gastric resections (BII), 15% Whipple's procedures, 4% segmental colonic resections, 18% right-sided -, 4% left-sided hemicolectomies, 22% sigmoid- or anterior rectal resections and 2.5% total colectomies with pouch-anal anastomoses. Postoperative hospitalization was comparable in both groups. Postoperative motility (time to full oral diet, time with NG tube) was also comparable. Anastomotic insufficiencies were observed in 2.1% of all patients, 5 of those after stapled, 2 after hand sewn anastomoses. Hospital mortality was 1.5%, one patient died after insufficiency of her handsewn anastomoses, the others of diseases unrelated to the operative technique. All stapled reconstructions were performed significantly faster (p<0.001). The cost of material for stapled anastomoses though was significantly higher (p<0.001) resulting in significantly higher (p<0.001) total expenses for all stapled anastomoses. The total operative time was not significantly different (aside from stapled gastrectomy) for the two groups. All operations performed with a stapled reconstruction were therefore more expensive than those with sutured reconstruction, reaching significance for the gastrectomy (p<0.01), colonic resection (p<0.01) and sigmoid- and anterior rectal resection (p<0.001) groups.
Conclusion: Stapled and sutured anastomoses in GI surgery are equally efficient. Stapled anastomoses are not cost -effective though and should be reserved to individual indications.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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