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Randomized Controlled Trial
. 2025 Oct 3;40(1):207.
doi: 10.1007/s00384-025-04973-z.

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

Raashid Hamid  1 , Ubayer Nabi  2 , Akshat Sudhanshu  2 , Vivek Sharma  2 , Sabina Nisar  2 , Nisar A Bhat  2 , Ajaz A Baba  2 , Gowhar N Mufti  2 , Waseem Jan Shah  2 , Mir Faheem Ul Hassan  2
Affiliations
Randomized Controlled Trial

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

Raashid Hamid et al. Int J Colorectal Dis. .

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).

Keywords: Anastomotic leaks; Bowel movements; Colorectal surgery; Gastrointestinal anastomosis; Hand-sewn anastomosis; Hospital stay; Infant surgery; Loop colostomy; Operative time; Pediatric colostomy; Pediatric surgery; Postoperative recovery; Stapled anastomosis; Surgical outcomes; Surgical techniques.

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Conflict of interest statement

Declarations. Ethics statement & consent to participate: The studies involving humans were approved by IEC; Order No. SIMS 137–2023-48/IEC-SKIMS The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was Signed by the participants’ legal guardians/next of kin. Consent for publication: Consent for publication consent for publication was obtained from the parents of the child. The consent is included in the medical records of the patient.Consent for publication consent for publication was obtained from the parents of the child. The consent is included in the medical records of the patient. Competing interests: The authors declare no competing interests.The authors declare no competing interests. CONSORT compliance statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised in accordance with the CONSORT 2010 guidelines for reporting randomized controlled trials.

Figures

Fig. 1
Fig. 1
Consort flow diagram
Fig. 2
Fig. 2
Dissected colostomy loops positioned side by side in preparation for anastomosis
Fig. 3
Fig. 3
Insertion of the linear stapler for side-to-side anastomosis between the two colostomy loops
Fig. 4
Fig. 4
Common side-to-side cavity created after firing the linear stapler across the colostomy loops
Fig. 5
Fig. 5
Positioning of the transverse stapler for closure of the common enterotomy after side-to-side anastomosis
Fig. 6
Fig. 6
Completion of anastomosis following the second firing of the linear stapler to close the common enterotomy
See this image and copyright information in PMC

References

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