Impact of Surgical Experience on Burst Pressure of Hand-Sewn and Stapled Anastomoses

Introduction: Both hand-sewn and stapled techniques for creating small bowel anastomoses are safe and have similar rates for leaks and stricture. Each technique comes with its own benefits and detriments, but a well-trained surgeon should be proficient in both anastomotic techniques. The understanding of tissue layers and meticulous technique needed to perform a proper hand-sewn anastomoses require greater skill and experience than a stapled anastomosis to achieve comparable results. This study is aimed to determine if there is a difference in anastomotic burst pressure between hand-sewn versus stapled anastomoses when they were performed by surgeons with differing years of experience. Methods: Attending and resident surgeons with varying experience followed standardized instructions to create a hand-sewn and stapled anastomosis using segments of swine small intestine. Burst pressure was measured by inflating the intestine with air and using a manometer to record the pressure at which air leaked from the anastomosis. Results: Thirteen participants with 1-11 y of experience took part in this study. Burst pressure ranged between 4 and 76 mmHg for hand-sewn and 9 to 40 mmHg for stapled anastomoses. The mean burst pressures of stapled anastomoses were equal between less (mean = 29.0 mmHg, standard deviation [SD] = 8.54) and more (mean 29.0 mmHg, SD = 12.36) experienced surgeons. The difference in mean burst pressure of hand-sewn anastomoses for less experienced surgeons (mean = 34.6 mmHg, SD = 21.8) and more experienced surgeons (mean = 24.8 mmHg, SD = 5.26) was not statistically significant (P = 0.09). However, there was a significant difference between the SDs of the hand-sewn anastomoses of less and more experienced surgeons (P = 0.01, F = 17.1, F Crit = 9.2). There was no significant difference in our secondary outcome, mean burst pressure between hand-sewn 30.5 mmHg (SD = 18.4) and stapled anastomoses 29.0 mmHg (SD = 11.07)