User Rating: 5 / 5

Introduction: Although abdominal surgery has been practiced for centuries, only during the last 200 years, surgeons have mastered the sewing techniques on the intestine.

The improvements in surgical techniques, anesthesia, diagnostic accuracy, and antibiotic prophylaxis have contributed to the improvement of surgical results, which increases the reliability of surgeons in the success of surgery are the factors needed to provide a safe anastomosis. Among the most important factors affecting anastomosis are not only the individual characteristics of each patient but also the local factors and techniques such as a good blood supply, tension-free anastomosis, lack of coexisting diseases, and lack of obstructive elements nearby the anastomosis.

The decision of a surgeon to choose which anastomosis technique to apply is a combination of personal preference and the documented advantages that the technique entails. In the course of scientific documentation for manual anastomosis and stapler studies, numerous studies have been attempting to identify significant advantages of staplers, such as less tissue manipulation, minimization of tissue trauma, bleeding, edema, faster recovery, gastrointestinal tract functionality, and shorter recovery time.

In contrast, other studies have criticized the use of staplers as a cost-plus and considered the method related to frequent recurrences, post-operative stenosis, and tumor local re-occlusion at the anastomoses zone. Retrospective studies have often led to controversial results. So, the reduction of operating time was not associated with a significant decrease in anastomotic deities and mortality, but anastomotic stenoses (although not of statistical significance) were added. 

The birth of the Stapler has made more possible the lower anastomoses in patients that would be candidates for amputation of the rectum with the abdominoperineal method sec Miles if the manual technique was the method of choice. Their use impacts the increase of operator costs but this should not affect their use when needed.

The surgeon should have access to the use of both methods in performing anastomoses, only in this way priority will be given to the patient along with the choice of the methodology most appropriate to him/her. Apart from every surgeon’s desire to embrace contemporary methods, the surgeon should use the technique he is best at, without ever seeing the clock. 

The purpose of this monograph is to compare and evaluate manually performed rectal anastomoses and mechanical anastomoses with Stapler...

Keywords: Colorectal cancer, Surgical technique, anastomosis, Complications