A Dissertation on

‘’ A COMPARATIVE STUDY BETWEEN STAPLER ANDHANDSEWN ANASTOMOSIS IN GASTROINTESTINAL

SURGERIES IN COIMBATORE MEDICAL COLLEGE HOSPITALCOIMBATORE’’

Dissertation Submitted to

THE TAMIL NADU Dr.M.G.R. MEDICAL UNIVERSITY

CHENNAI- 600032

with partial fulfillment of the regulations

for the award of the degree of

M.S. GENERAL SURGERY

(BRANCH 1)

COIMBATORE MEDICAL COLLEGE,

COIMBATORE

MAY 2018

CERTIFICATE

Certified that this is the Bonafide Dissertation in "A COMPARATIVE

STUDY BETWEEN STAPLER AND HANDSEWN ANASTOMOSIS

IN GASTROINTESTINAL SURGERIES IN COIMBATORE

MEDICAL COLLEGE HOSPITAL COIMBATORE" was a work done

by Dr.MAGESHWARAN.B and submitted in partial fulfillment of the

requirements for the Degree of M.S.General Surgery, Branch I of The

Tamilnadu Dr.M.G.R Medical University, Chennai.

Date: Professor and Unit Chief

Department of General Surgery

Coimbatore Medical College.

Date: Professor and HOD

Department of General Surgery

Coimbatore Medical College.

Date: The DEAN

Coimbatore Medical College

DECLARATION

I Solemnly declare that the Dissertation titled "A COMPARATIVE

STUDY BETWEEN STAPLER AND HANDSEWN ANASTOMOSIS

IN GASTROINTESTINAL SURGERIES IN COIMBATORE

MEDICAL COLLEGE HOSPITAL COIMBATORE" was done by me

at Coimbatore Medical College during the academic year July 2016 – June

2017 under the guidance of Prof. Dr.V.Elango, M.S. this Dissertation is

submitted to the Tamilnadu Dr.M.G.R Medical University towards the

fulfillment of the requirement for the award of M.S. Degree in General

Surgery (Branch).

PLACE: Dr.MAGESHWARAN.B

DATE:

ACKNOWLEDGEMENT

I express my gratitude to Dr.B.Asokan, M.S, MCh, the Dean, Coimbatore

Medical College Hospital for providing facilities to carry out my project

work successfully.

I sincerely thank Prof. Dr. V.Elango, M.S, Chief and HOD, Department of

General Surgery for his constant guidance and encouragement throughout

the period of my study.

I would like to express my gratitude to my guides Prof. Dr. Natarajan M.S,

Prof. Dr. Ranganathan M.S, Prof.Dr.Balasubramanian Prof.

Dr. Shanthi M.S and Prof. Dr. Nirmala M.S, for their valuable guidance

and encouragement throughout the period of my study.

I would like to give special thanks to Dr. Meena M.S,DGO.,

Dr.Muthulakshmi M.S.DGO., Dr.Ravi M.S, Assistant Professors,

Department of General Surgery for their voluntary and useful guidance and

support.

PLACE: Dr.MAGESHWARAN.B

CERTIFICATE – II

This is to certify that this dissertation work titled "A COMPARATIVE

STUDY BETWEEN STAPLER AND HANDSEWN ANASTOMOSIS

IN GASTROINTESTINAL SURGERIES IN COIMBATORE

MEDICAL COLLEGE HOSPITAL COIMBATORE" of the candidate

Dr.MAGESHWARAN.B with registration Number 221511307 for the

award of M.S in the branch of General Surgery, I personally verified the

urkund.com website for the purpose of plagiarism Check. I found that the

uploaded thesis file contains 84 pages from introduction to conclusion and

the result shows 10% (Ten) percentage of plagiarism in the dissertation.

Guide & Supervisor sign with Seal.

\

INDEX

SR.NO CONTENT PAGE NO.

I INTRODUCTION1

II AIMS OF THE STUDY4

III REVIEW OF LITERATURE5

IV MATERIALS AND METHODS58

V RESULTS60

VI DISCUSSION78

VII CONCLUSION84

VIII BIBLIOGRAPHY85

IX

ANNEXURES

PROFORMA

CONSENT FORM

MASTER CHART

91

95,96

98

LIST OF FIGURES

FIG NO TITLE PAGE NO

1. LEMBERT SUTURE 4

2 HORIZONTAL MATTRESS (HALSTED)

SUTURE

5

3. CONNELL SUTURE 6

4. GAMBEE SUTURE 7

5. LINEAR NON-CUTTING STAPLERS 10

6. LINEAR CUTTING STAPLERS 10

7. CURVILINEAR CUTTING(CONTOUR)

STAPLERS CIRCULAR STAPLERS

11

8 CIRCULAR STAPLERS 12

9. STRUCTURES RELATED TO STOMACH 17

10 BLOOD SUPPLY OF FOREGUT 19

11. BILLROTH -I 21

12. BILLROTH - II 22

13.GASTROJEJUNOSTOMY

23

14. ANATOMY OF THE COLON 26,27

15. ANATOMY OF CAECUM 29

16. POSTERIOR RELATIONS OF ASCENDING

COLON

32

17POSTERIOR RELATIONS OF

TRANSVERSE COLON

33

18SIGMOID COLON

36

19. LAPAROSCOPIC PORT SITES FOR

COLOANAL ANASTOMOSIS

41

20.DIVISION OF THE INFERIOR MESENTRIC

VESSELS AND COLON MOBILIZATION

42

21HAND SEWN COLONIC POUCH ANAL

ANASTOMOSIS

47

22. HANDSEWN SIDE-TO-END ANASTOMOSIS 56

23. 1. HANDSEWN JEJUNOJEJUNAL

ANASTOMOSIS

2. STAPLER ILEOTRANSVERSE

ANASTOMOSIS

59

LIST OF TABLES

1. TYPES OF ANASTOMOSIS 60

2. DISTRIBUTION OF SEX 61

3. CROSSTABS FOR GENDER

DISTRIBUTION

62

4. ELECTIVE VERSUS EMERGENCY 63

5. CROSSTABS FOR ELECTIVE /

EMERGENCY GROUPS

64

6. AGE GROUP COMPARISON 65

7. CROSSTABS FOR AGE GROUP 66

8. DURATION OF SURGERY 68

9. POST OPERATIVE GIT MOTILITY IN DAYS 69

10. HOSPITAL STAY IN DAYS 70

11. COMPLICATIONS GROUPS 71

12. T - TEST FOR GROUP STATISTICS 76

13. INDEPENDENT SAMPLES TEST 77

LIST OF CHARTS

S.NO CHARTS PAGE NO

1. TYPES OF ANASTOMOSIS 60

2. DISTRIBUTION OF SEX 61

3. GENDER DISTRIBUTION FOR TYPE OF

ANASTOMOSIS

62

4. ELECTIVE VERSUS EMERGENCY 63

5. TYPE OF ANASTOMOSIS IN ELECTIVE /

EMERGENCY GROUPS

64

6. AGE GROUP COMPARISON 65

7. AGE GROUP COMPARISON FOR TYPE OF

ANASTOMISIS

67

8. DURATION OF SURGERY 68

9. POST OPERATIVE GIT MOTILITY IN DAYS 69

10. HOSPITAL STAY IN DAYS 70

11. COMPLICATIONS GROUPS 73

ABBREVATIONS

GIT-Gastro Intestinal tract

VIP-Visible intestinal peristalsis

VGP-Visible Gastric peristalsis

GJ-Gastro Jejunostomy

JJ-Jejuno jejunostomy

APR-Abdomino perineal resection

CAA-Colo anal anastomosis

OGD-Oesophago gastro duodenoscopy

CECT-Contrast Enhanced Computerised Tomography

LFT-Liver function test

PR-Per rectal

D.O.A-Date of admission

D.O.S-Date of surgery

D.O.D-Date of discharge

I.P.NO-In patient number

closed staple length of 1 mm. Tissue staplers have “blue” cartridges and

“green” cartridges that are used for thin tissues and thick tissues,

“blue” stapler is 1.5 mm is used for small

bowel, colon, and esophagus. The closed staple length of a “green” stapler is

create staple heights within a “firing” range at the point th

the apex of the “V”

between the patient’s legs to

placed at 3, 6, 9, and 12 o’clock, and then an additional one or two

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lubricant and the assistant’s fingers. The spindle is slowly advanced

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Technological advancement in surgeons’ own hands. Arq

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I, …………………………. do hereby volunteer and consent to