Article Data

  • Views 676
  • Dowloads 196

Original Research

Open Access

Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

  • Guner Cakmak1
  • Fikret Halis2
  • Emre Gonullu1
  • Haci Ibrahim Cimen2
  • Anil Erdik2
  • Kayhan Ozdemir1

1Department of General Surgery, Sakarya Training and Research Hospital, 54100 Sakarya, Turkey

2Department of Urology, Sakarya Training and Research Hospital, 54290 Sakarya, Turkey

DOI: 10.31083/jomh.2021.107 Vol.17,Issue 4,September 2021 pp.243-248

Submitted: 17 June 2021 Accepted: 17 August 2021

Published: 30 September 2021

*Corresponding Author(s): Guner Cakmak E-mail:

PDF (201.84 kB)


Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost.

Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups.

Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001).

Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.


Bladder cancer; Ileal loop; Ileal conduit; Handsewn; Stapler

Cite and Share

Guner Cakmak,Fikret Halis,Emre Gonullu,Haci Ibrahim Cimen,Anil Erdik,Kayhan Ozdemir. Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy. Journal of Men's Health. 2021. 17(4);243-248.


[1] Burger M, Catto JWF, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Epidemiology and risk factors of urothelial bladder cancer. European Urology. 2013; 63: 234–241.

[2] Ploeg M, Aben KKH, Kiemeney LA. The present and future burden of urinary bladder cancer in the world. World Journal of Urology. 2009; 27: 289–293.

[3] Stein JP, Lieskovsky G, Cote R, Groshen S, Feng A, Boyd S, et al. Radical Cystectomy in the Treatment of Invasive Bladder Cancer: Long-Term Results in 1,054 Patients. Journal of Clinical Oncology. 2001; 19: 666–675.

[4] Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk MA, Merseburger AS, et al. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. European Urology. 2009; 55: 815–825.

[5] Marulli G, Breda C, Fontana P, Ratto GB, Leoncini G, Alloisio M, et al. Pleurectomy-decortication in malignant pleural mesothelioma: are different surgical techniques associated with different outcomes?Results from a multicentre study. European Journal of Cardio-Thoracic Surgery. 2017; 52: 63–69.

[6] Bongiolatti S, Corzani R, Borgianni S, Meniconi F, Cipollini F, Gonfiotti A, et al. Long-term results after surgical treatment of the dominant lung adenocarcinoma associated with ground-glass opacities. Journal of Thoracic Disease. 2018; 10: 4838–4848.

[7] Siddiqui KM, Izawa JI. Ileal conduit: standard urinary diversion for elderly patients undergoing radical cystectomy. World Journal of Urology. 2016; 34: 19–24.

[8] Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, Mills RD, et al. Urinary diversion. Urology. 2007; 69: 17–49.

[9] Williams O, Vereb MJ, Libertino JA. Noncontinent urinary diversion. The Urologic Clinics of North America. 1997; 24: 735–744.

[10] Nicolau AE. Temporary loop-ileostomy for distal anastomosis protec-tion in colorectal resections. Chirurgia. 2011; 106: 227–232.

[11] Abreu SC, Araújo MB, Silveira RA, Regadas RP, Pinheiro DG, Messias FI, et al. Laparoscopic-assisted radical cystectomy with U-shaped orthotopic ileal neobladder constructed using nonabsorbable titanium staples. Urology. 2006; 68: 193–197.

[12] Grubb RL, Sundaram CP, Yan Y, Chen C, McDougall EM, Clayman RV. Use of titanium staples during upper tract laparoscopic recon-structive surgery: initial experience. The Journal of Urology. 2002; 168: 1366–1369.

[13] Kravchick S, Lobik L, Paz A, Stepnov E, Ben-Dor D, Cytron S. Radical cystectomy with W-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples-long term follow-up. International Brazilian Journal of Urology. 2013; 39: 167–172.

[14] BRICKER EM. Bladder substitution with isolated small intestine segments; a progress report. The American Surgeon. 2002; 18: 654–664.

[15] Bolliger M, Kroehnert J, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. European Surgery. 2018; 50: 256–261.

[16] Tanna RJ, Powell J, Mambu LA. Ileal Conduit. In StatPearls. Treasure Island (FL): StatPearls Publishing. 2021.

[17] de Vermandois JAR, Cochetti G, Zingaro MD, Santoro A, Panciarola M, Boni A, et al. Evaluation of Surgical Site Infection in Mini-invasive Urological Surgery. Open Medicine. 2019; 14: 711–718.

[18] Caputo PA, Ramirez D, Maurice M, Nelson R, Kara O, Malkoc E, et al. Robotic Assisted Radical Cystoprostatectomy and Intracorporeal Ileal Conduit Urinary Diversion for a Kidney Transplant Recipient. International Brazilian Journal of Urology. 2017; 43: 1192.

[19] Sato K, Uchida H, Tanaka Y, Takazawa S, Jimbo T, Deie K. Stapled intestinal anastomosis is a simple and reliable method for management of intestinal caliber discrepancy in children. Pediatric Surgery International. 2012; 28: 893–898.

[20] Prcic A, Begic E. Complications after Ileal Urinary Derivations. Medical Archives. 2017; 71: 320–324.

[21] Li Z, Liu Z, Yao K, Qin Z, Han H, Li Y, et al. An improved ileal conduit surgery for bladder cancer with fewer complications. Cancer Communications. 2019; 39: 19.

[22] He X, Chen Z, Huang J, Lian L, Rouniyar S, Wu X, et al. Stapled side-to-side anastomosis might be better than handsewn end-to-end anastomosis in ileocolic resection for Crohn’s disease: a meta-analysis. Digestive Diseases and Sciences. 2014; 59: 1544–1551.

[23] Haverkamp L, van der Sluis PC, Verhage RJJ, Siersema PD, Ruurda JP, van Hillegersberg R. End-to-end cervical esophagogastric anastomoses are associated with a higher number of strictures compared with end-to-side anastomoses. Journal of Gastrointestinal Surgery. 2013; 17: 872–876.

[24] Kılıçoğlu B, Kılıçoğlu S, Göçen V. Gastrointestinal sistemde yara iyileşmesi. Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi. 2009; 12: 67–76. (In Turkish)

[25] Hill TM, Onugha O. Stapled Diaphragmatic Plication: Is It Better Than Suture Plication? Surgical Technology International. 2020; 36: 270–273.

[26] Liu Q, Min J, Deng X, Dai J. Is hand sewing comparable with stapling for anastomotic leakage after esophagectomy? A meta-analysis. World Journal of Gastroenterology. 2014; 20: 17218–17226.

[27] Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU International. 2014; 113: 11–23.

[28] Kavaric P, Eldin S, Nenad R, Dragan P, Vukovic M. Modified wallace anastomotic technique reduces ureteroenteric stricture rates after ileal conduit urinary diversion. International Brazilian Journal of Urology. 2020; 46: 446–455.

[29] Lustosa SADS, Matos D, Atallah AN, Castro AA. Stapled versus handsewn methods for colorectal anastomosis surgery: a systematic review of randomized controlled trials. Sao Paulo Medical Journal. 2002; 120: 132–136.

[30] Olmez T, Uzun O, Ozduman O, Gulmez S, Oz A, Polat E, et al. Is the use of a stapler for ileocolic anastomosis linked to anastomotic leakage?Medical Journal of Bakirkoy. 2020; 16: 256–262.

[31] Loertzer P, Siemer S, Stöckle M, Ohlmann CH. Robot-sewn ileoileal anastomosis during robot-assisted cystectomy. World Journal of Urology. 2018; 36: 1079–1084.

Abstracted / indexed in

Science Citation Index Expanded Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Social Sciences Citation Index Social Sciences Citation Index contains over 3,400 journals across 58 social sciences disciplines, as well as selected items from 3,500 of the world’s leading scientific and technical journals. More than 9.37 million records and 122 million cited references date back from 1900 to present.

Current Contents - Social & Behavioral Sciences Current Contents - Social & Behavioral Sciences provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in the social and behavioral sciences.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

SCOPUS Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

DOAJ DOAJ is a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals.

CrossRef Crossref makes research outputs easy to find, cite, link, assess, and reuse. Crossref committed to open scholarly infrastructure and collaboration, this is now announcing a very deliberate path.

Portico Portico is a community-supported preservation archive that safeguards access to e-journals, e-books, and digital collections. Our unique, trusted process ensures that the content we preserve will remain accessible and usable for researchers, scholars, and students in the future.

Submission Turnaround Time