“Since Ravitch and Steichen introduced a modified form of the Soviet-developed stapling instruments in the 1960s, various types of staplers and stapling techniques have been adopted worldwide. There are two main types of stapled intestinal anastomoses: anatomical end-to-end anastomoses, performed with circular staplers, and functional side-to-side anastomoses, performed with linear staplers. According to several studies, stapled anastomoses have rendered hand-sewn anastomoses obsolete. It is known that less time is required for stapled intestinal anastomosis than for conventional hand-sewn anastomosis, and that the rate of anastomostic-related complications after stapling is acceptably low. However, some articles have pointed out that stapled anastomoses are unfavorable in certain situations. To our knowledge there are no papers in the literature comparing stapled and manual anastomosis in emergency traumatic or nontraumatic intestinal surgery. Thus, we conducted a prospective randomized study to compare emergency intestinal surgical
stapling with manual suturing.”

“Anastomoses in emergency surgery are usually performed in critically ill patients under difficult situations. Thus, because minimizing the operating time can be very important, faster anastomoses using the stapling technique may be fundamental. Moreover, patients
treated in an emergency situation have not been prepared as in elective surgery, creating additional risk factors. Our study was carried out in a single institution by surgeons very experienced in suturing and stapling in emergency intestinal surgery, thereby minimizing the
“surgeon risk factor.” Other variables, such as antibiotic prophylaxis and anastomotic technique, can influence the integrity of anastomosis. In our center, these variables were standardized because antibiotic prophylaxis was based on the NNISS protocol and the same anastomotic technique was used by surgeons. Moreover, the overall incidence of anastomotic leakage was comparable with that of most reported series, demonstrating
the quality of our standards. There was no difference in the rate of anastomotic leakage between manual and stapled anastomoses, either of small bowel or colorectal anastomoses, despite a previous report that hand suturing resulted in a lower incidence of colorectal anastomosis leakage.”

Catena, Fausto et al. “Stapled versus hand-sewn anastomoses in emergency intestinal surgery: results of a prospective randomized study.” Surgery today vol. 34,2 (2004): 123-6. Full Text for Emory Users