A Comparative Study of Stapled versus Hand-Sewn Bowel Anastomosis in Patients Undergoing Bowel Surgery: Safety, Operative Efficiency, Hospital Stay, and Cost Analysis

Abstract

Background: Bowel anastomosis is a fundamental component of gastrointestinal surgery, and the choice between stapled and hand-sewn techniques may significantly influence surgical outcomes. This study compared the two techniques with respect to anastomotic safety, operative efficiency, postoperative recovery, hospital stay, and overall treatment cost.

Methods: A single-centre, hospital-based observational comparative study was conducted over 18 months at JSS Medical College, Mysuru, involving 40 adult patients undergoing bowel resection and anastomosis. Patients were allocated into stapled (n=20) and hand-sewn (n=20) groups. Baseline demographic and clinical characteristics, operative details, anastomotic leak, anastomosis duration, postoperative bowel recovery, hospital stay, treatment cost, and 30-day postoperative outcomes were evaluated and compared.

Results: Both groups were comparable regarding baseline characteristics, including age (47.6 ± 13.4 vs 49.8 ± 12.9 years), sex distribution (65.0% vs 60.0% males), symptom duration, comorbidities, and laboratory parameters. Acute abdomen was the indication for surgery in 75.0% of patients in both groups, while revision ileostomy-related pathology accounted for 25.0%. Small bowel pathology predominated, with segmental small bowel resection performed in 50.0% and 55.0% of stapled and hand-sewn cases, respectively. Side-to-side anastomosis was significantly more common in the stapled group (65.0% vs. 25.0%, p=0.025). Stapled anastomosis demonstrated significantly shorter anastomosis duration (24.6 ± 5.8 vs. 35.9 ± 8.7 minutes, p<0.001), earlier return of bowel sounds by postoperative day 3 (85.0% vs. 50.0%, p=0.041), lower anastomotic leak rate (0.0% vs. 25.0%, p=0.042), and shorter hospital stay (7.1 ± 2.1 vs. 10.4 ± 4.2 days, p=0.004). However, overall treatment cost was significantly higher with stapled anastomosis (₹85,240 vs. ₹68,430, p=0.001). No 30-day mortality was observed.

Conclusion: Stapled bowel anastomosis was associated with superior short-term clinical outcomes, including reduced anastomotic leak, shorter operative time, faster postoperative recovery, and shorter hospital stay compared with hand-sewn anastomosis, although it incurred higher treatment costs.