Stapled Versus Hand‐Sewn Anastomosis in Emergency Gastrointestinal Surgery, A NARRATIVE REVIEW

Abstract

Background: Intestinal anastomosis is a pivotal step in gastrointestinal surgery, particularly in emergency settings where adverse physiological conditions may compromise healing. While hand-sewn techniques have been the traditional standard, mechanical stapling has become increasingly popular due to perceived advantages in speed and consistency. However, the optimal technique in emergency gastrointestinal surgery remains debated.

Objective: To review and synthesize current evidence comparing stapled versus hand-sewn intestinal anastomoses in emergency gastrointestinal surgery, with reference to relevant elective data, focusing on operative efficiency, anastomotic integrity, clinical outcomes, and resource implications.

Methods: A narrative literature review was conducted using PubMed, Cochrane Library, and Google Scholar. Randomized controlled trials, observational studies, systematic reviews, and meta-analyses comparing stapled and hand-sewn anastomoses were included, with emphasis on emergency procedures across gastrointestinal organ systems. Evidence from both high-income and low-/middle-income country settings was considered. Due to heterogeneity of study designs and populations, findings were synthesized qualitatively.

Results: Across emergency gastrointestinal surgery, stapled and hand-sewn anastomoses demonstrate comparable rates of anastomotic leak, morbidity, and mortality. Stapling consistently reduces operative time and may improve efficiency, which is advantageous in critically ill or unstable patients. Leak rates appear similar overall, although stapled anastomoses may offer modest benefits in selected elective settings, particularly right-sided ileocolic resections. Stricture rates vary by anatomical site, with some evidence of higher stricture risk following stapled esophagogastric anastomosis. Cost-effectiveness favors stapling in high-resource systems due to reduced operative time and complication-related costs, whereas hand-sewn techniques remain more practical in resource-limited settings.

Conclusion: Current evidence does not demonstrate clear superiority of stapled or hand-sewn anastomosis in emergency gastrointestinal surgery. Stapling offers efficiency advantages without compromising safety, while hand-sewn anastomosis remains a reliable and flexible option, particularly in challenging tissues or low-resource environments. Technique selection should be individualized based on patient condition, anatomical factors, surgeon expertise, and resource availability. High-quality, emergency-focused trials—especially from low- and middle-income countries—are needed to refine evidence-based recommendations.