Introduction: Intestinal anastomosis can be performed by hand suturing (single layer or double layer) or by a mechanical suturing machine. The aim of the study was to compare complications, operative time, and costs of the intestinal anastomosis techniques. Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy and uretero-ileo-cutaneostomy or vescica ileale Padovana orthotopic neobladder. Double-layered hand-sewn intestinal anastomosis (HS-IA) were performed using Vicryl stitches. Mechanical-stapled intestinal anastomosis (MS-IA) were performed with a mechanical stapler. Results: Data of 195 patients who underwent were collected. 100 (51.3%) patients underwent HS-IA and 95 (48.7%) patients underwent MS-IA. Considering the complications classified according to Clavien-Dindo, a statistical difference with higher incidence for grade one in the HS-IA both in the ileal conduit group and in the neobladder one than the MS-IA (15.8% and 8.7%, respectively, in HS-IA vs. 1.7% and none in MS-IA). There is not a significant difference in time to flatus and time to defecation. Difference is recorded in the ileal conduit groups for the length of stay (10 days, range 9–12 with HS-IA vs. 13 days range 12–16 days with MS-IA (p < 0.001). The cost of the suture thread used for a single operation was 0.40 euros, whereas the overall cost of a disposable mechanical stapler and one refill was 350.00 €. Conclusion: Both HS-IA and MS-IA are safe and effective for patients. The cost for the stapling device is 350 €, in contrast, the cost for Vicryl sutures is negligible.

1.
Hautmann
RE
,
Gschwend
JE
,
de Petriconi
RC
,
Kron
M
,
Volkmer
BG
.
Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era
.
J Urol
.
2006
;
176
(
2
):
486
92
; discussion 491-2.
2.
Alfred Witjes
J
,
Lebret
T
,
Comperat
EM
,
Cowan
NC
,
De Santis
M
,
Bruins
HM
.
Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer
.
Eur Urol
.
2017
;
71
(
3
):
462
75
.
3.
Babjuk
M
,
Burger
M
,
Comperat
EM
,
Gontero
P
,
Mostafid
AH
,
Palou
J
.
European association of urology guidelines on non-muscle-invasive bladder cancer (TaT1 and Carcinoma in Situ): 2019 update
.
Eur Urol
.
2019
;
76
(
5
):
639
57
.
4.
Lenis
AT
,
Lec
PM
,
Chamie
K
,
Mshs
MD
.
Bladder Cancer: A Review JAMA
2020 Nov 17
.
5.
AIOM guidelines 2020
.
6.
Brown
KGM
,
Solomon
MJ
,
Latif
ER
.
Urological complications after cystectomy as part of pelvic exenteration are higher than that after cystectomy for primary bladder malignancy
.
J Surg Oncol
.
2017 Mar
115
3
307
11
.
7.
Pagano
F
,
Artibani
W
,
Ligato
P
,
Piazza
R
,
Garbeglio
A
,
Passerini
G
.
Vescica Ileale Padovana: a technique for total bladder replacement
.
Eur Urol
.
1990
;
17
(
2
):
149
54
.
8.
ScottFarnham
B
,
Cookson
ÆMS
Surgical complications of urinary diversion)
.
9.
AljaberyJancke
FG
,
Skoglund
P
,
Hallbook
O
.
Stapled versus robot-sewn ileo-ileal anastomosis during robot-assisted radical cystectomy: a review of outcomes in urinary bladder cancer patients
.
Scand J Urol
.
2021
;
55
(
1
):
41
5
.
10.
Choy
PYG
,
Bissett
IP
,
Docherty
JG
Stapled versus handsewn methods for ileocolic anastomoses Cochrane database syst rev
.
2007
.
11.
Slesser
AAP
,
Pellino
G
,
Shariq
O
,
Cocker
D
,
Kontovounisios
C
,
Rasheed
S
.
Compression versus hand-sewn and stapled anastomosis in colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
.
Tech Coloproctol
.
2016 Oct
20
10
667
76
.
12.
Peeters
KC
,
Tollenaar
RA
,
Marijnen
CA
,
Klein Kranenbarg
E
,
Steup
WH
,
Wiggers
T
.
Risk factors for anastomotic failure after total mesorectal excision of rectal cancer
.
Br J Surg
.
2005
;
92
(
2
):
211
6
.
13.
Hyman
N
,
Manchester
TL
,
Osler
T
,
Burns
B
.
Cataldo PA Anastomotic leaks after intestinal anastomosis: it’s later than you think
.
Ann Surg
.
2007
.
14.
Ballantyne
GH
.
The experimental basis of intestinal suturing. Effect of surgical technique, inflammation, and infection on enteric wound healing
.
Dis Colon Rectum
.
1984
.
15.
Neutzling
CB
,
Lustosa
SA
,
Proenca
IM
,
da Silva
EM
,
Matos
D
.
Stapled versus handsewn methods for colorectal anastomosis surgery
.
Cochrane Database Syst Rev
.
2012
2
.
16.
Luglio
G
,
Corcione
F
Stapled versus handsewn methods for ileocolic anastomoses. Techniques in Coloproctology
.
July 2019
.
17.
Wakam
GK
,
Alam
HB
.
One layer or two: Does it matter when performing a handsewn bowel anastomosis? Invited Commentary on “Efficacy of single layered intestinal anastomosis over double layered intestinal anastamosis-an open labeled, randomized controlled trial.”
.
Int J Sur
.
2020 Jul
79
321
2
.
18.
Pirhan
Y
,
Gök
K
,
Gök
A
.
Comparison of two different bowel anastomosis types using finite Volume method
.
Comput Methods Biomech Biomed Engin
.
2020 Jun
23
8
323
31
.
You do not currently have access to this content.