Optimizing pediatric loop colostomy closure: a comparative study of linear stapler and hand-sewn anastomosis.

Abstract

Background: Conventional hand suture techniques for intestinal anastomosis have been standard practice for decades, but the development of staplers has significantly impacted surgical procedures. Staplers, designed to simplify surgery, have been increasingly used in various gastrointestinal surgeries, including pediatric procedures. Colostomy takedown in infants is a commonly performed surgical procedure in pediatric surgery, yet the optimal technique remains debated. This study aims to compare the outcomes of linear stapler anastomosis and hand-sewn anastomosis for elective closure of loop colostomies in children. The hypothesis is that linear stapler anastomosis offers advantages over hand-sewn anastomosis in terms of operative time, recovery, and hospital stay.

Aim: To compare the outcomes of linear stapler and hand-sewn anastomosis in the elective closure of pediatric loop colostomies.

Methods: This prospective, randomized controlled study was conducted at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, J&K, India, between 2021 and 2023. A total of 70 infants were enrolled, randomly assigned to two groups: Group A (35 infants) underwent SA (Stapled Anastomosis), and Group B (35 infants) underwent HS (Hand-Sewn Anastomosis). Both groups were matched for clinical characteristics. The primary outcomes included operative time and time to return of bowel movements. Secondary outcomes included anastomotic leaks, wound infections, and length of hospital stay. Data analysis was performed using appropriate statistical methods including t-tests and chi-square tests.

Results: The mean age of patients was 5.79 ± 3.23 months in Group A and 4.21 ± 3.13 months in Group B. The mean time to return of bowel movements was significantly shorter in Group A (24.82 ± 6.34 h) compared to Group B (47.56 ± 5.65 h, p = 0.05). Oral feeding was commenced earlier in Group A (2.18 ± 0.39 days) than in Group B (3.16 ± 0.37 days, p < 0.001). Both groups had a follow-up of 1.81 ± 0.98 years, with no cases of anastomotic leakage or small bowel obstruction in either group. Hospital stay was shorter in Group A (53.82 ± 6.34 h) compared to Group B (79.56 ± 15.65 h, p < 0.0003).