MP25-19: Comparison of complications, operating time and costs in double-layered hand-sewn vs. mechanical stapled ileo-ileal anastomosis during radical cystectomy

Gabriele Tulone*, Palermo, Italy, Nicola Pavan, Trieste, Italy, Sofia Giannone, Palermo, Italy, Giuseppe Alario, Messina, Italy, Alberto Abrate, Sondrio, Italy, Mirko Pinelli, Piero Mannone, Palermo, Italy, Francesco Claps, Trieste, Italy, Davide Baiamonte, Rosa Giaimo, Marco Vella, Carlo Pavone, Palermo, Italy, Vincenzo Ficarra, Messina, Italy, Alchiede Simonato, Palermo, Italy

Introduction: The Intestinal anastomosis during radical cystectomy (RC), can be performed by hand suturing or by a mechanical suturing machine. The purpose of the study is to compare complications, timing and costs of the intestinal anastomosis techniques

Methods: A multi-institutional cohort of 195 patients who underwent RC, performed by expert surgeons, from 2016 to 2021, were retrospectively analyzed. 100 (51.3%) double-layered hand-sewn intestinal anastomosis (HS-IA) with 2 Vicryl 3.0 and 2 Vicryl 4.0 stitches were performed. 95 (48.7%) mechanical stapled intestinal anastomosis (MS-IA) were conducted with a mechanical stapler (disposable Ethicon 75mm Linear Cutter from Johnson and Johnson) and 1 refill

Results: Of the 195 procedures, 100 patients underwent HS-IA and 95 underwent MS-IA. The median age was 71 years (IQR 65-77 years). Charlson comorbidity index and ASA score were higher in the MS-IA group. 29 (29%) patients of the HS-IA group reported early postoperative complications and in 34 (36%) patients were documented in the MS-IA group (p < 0.001). In the MS-IA group, 20 (21.1%) patients presented major complications according to Clavien Dindo, while only 6 patients (6%) had complications in the HS-IA group (p=0.03). In HS-IA group ileo-ileal anastomosis dehiscence occurred in 1 patient (1%); 1 patient (1%) had intestinal mechanical obstruction and 2 (2%) patients ileus in postoperative period. In the MS-IA group in 2 patients (2.1%) bowel perforation occurred, and intestinal obstruction in 2 patients was also reported. There is not a statistically difference in time to flatus and defecation, 2 days (IQR 2-3 days) vs 3 days (IQR 2-3 days) and 5 days (4-6 days) vs 5 days (4-6 days) respectively in the two groups. The median operating time for the hand-sewn anastomosis was 16.4 min (range 15.0-17.4 min), compared to 20.0 min (range 20.0 -20.0 min) p<0.001 for the mechanical suturing machine. The costs of the double-layered hand-sewn for a single patient is 5 €, against 350.00 € for a disposable mechanical stapler and one refill

Conclusions: Both HS-IA and MS-IA are safe and feasible without postoperative course differences but the HS-IA is less expensive and can reduce the operating time of the ileo-ileal anastomosis during RC. Additionally, MS-IA is reinforced with supplementary stitches and despite this, the risk of anastomosis dehiscence is not completely cancelled. Concluding, the HS-IA anastomosis is an important cost-saving approach compared to the stapled alternative.

Source of Funding: no