Handsewn versus stapled

Objective 5: Decision making between hand sewn versus stapled anastomosis

The state of the bowel needs to be carefully considered when deciding whether to do a handsewn or stapled anastomosis

• Stapled anastomosis is more uniform and faster to deliver
• Hand sewn anastomosis can be tailored to uneven or pathological bowel (e.g. in the presence of contamination or inflammation)

Both techniques should be part of the surgeon’s armamentarium, and one may be more appropriate than the other in certain situations.

This video shows a discussion between surgeons about selection between handsewn and stapled anastomoses:

Stapler manufacturers have clear guidelines about the tissue limits for stapler devices. This means that in certain situations, staplers may not be the safest or most appropriate choice of anastomosis type.

For example:

• Stapled anastomosis should not be used when the bowel is oedematous or thickened
• Handsewn anastomoses can be useful when mobilisation is difficult and length of bowel is poor (remember all anastomoses must be tension-free)

Harmonised techniques for both can help consistency and repeatability, reproducibility, training and assessment.

These are discussed in Module 4 and Module 5.

This video shows a discussion between surgeons and trainees about choosing between handsewn and stapled anastomoses: