Advantages of handsewn over stapled bowel anastomosis

Adam J. Dziki, Mark D. Duncan, John W. Harmon, Nirmal Saini, Richard A. Malthaner, Karim S. Trad, Marie T. Fernicola, Fawaz Hakki, Richard M. Ugarte

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Bowel anastomoses are conventionally performed using a handsewn technique or a stapling device. Each has potential benefits and disadvantages. The most clinically significant complications of the bowel anastomosis are anastomotic leakage and stricture formation. The indices of healing and tissue cohesion were compared dynamically over time in 24 dogs randomized to undergo either a standard two-layer handsewn anastomosis or a stapled anastomosis with the Premium CEEATM(United States Surgical Corporation, Norwalk, CT). Animals were sacrificed at 1, 4, 7, and 28 days postoperatively. Each anastomosis was evaluated for anastomotic index, burst pressure, collagen content, and histologic appearance. The anastomotic index was similar on postoperative day (POD) 1, 4, and 7; but on day 28 all handsewn anastomoses had larger diameters than the widest CEEATManastomosis. Burst pressure was higher in handsewn anastomoses at all intervals. Collagen content tended to be higher on POD 7 in the CEEATManastomoses. Histological evaluation showed more complete epithelialization and less inflammation in handsewn anastomoses on POD 28. The higher level of collagen in the CEEATManastomoses on POD 7 may be implicated in the tendency toward stricture formation found with this type of anastomosis. This study demonstrates that the greater speed and ease of the stapled anastomosis is offset by the greater strength, reduced tendency to stricture, and more complete healing of the handsewn anastomosis.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalDiseases of the Colon & Rectum
Issue number6
StatePublished - Jun 1991
Externally publishedYes


  • Colorectal surgery
  • Dogs
  • Surgical anastomosis
  • Surgical staplers
  • Suture techniques

ASJC Scopus subject areas

  • Gastroenterology


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