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Results concerning 819 digestive sutures and anastomoses, 376 (45.9%) of which hand sewn and 443 (54.1%) stapled, are retrospectively analyzed. Comparative evaluation of the two techniques yielded better results for oesophageal and rectal anastomoses as well as duodenal stump closure mechanically performed. For intestinal anastomoses the two techniques showed similar results when performed in election, on the contrary, mechanical sutures fared significantly worse than hand-sutures in non elective surgery, with a morbidity of 30.9% vs 10.2% (p less than 0.05) and a mortality of 4.8% vs 0%. In conclusion, for esophageal, rectal and duodenal anastomoses staplers may be preferred, while for the intestinal anastomoses in non elective surgery hand-sutures should be preferred.

Out of a total of 365 operations for colo-rectal disease performed during the period 1980-1989 at the III and V Division of General Surgery of the 2nd Faculty of Medicine and Surgery of Naples, 181 (49.6%) patients had rectosigmoidal cancer: 95 (52.5%) underwent anterior resection and 86 (47.5%) Miles' operation. In 46 patients who underwent mechanical anterior resection during the period 1986-1989, pre and postoperative sphincter function was studied through a complete anamnesis, physical examination, sigmoidoscopy or colonoscopy and balloon manometry. All data were analyzed considering both the distance of the anastomosis from the anal verge and the patient age in order to stress possible relations with incontinence. The low incidence of incontinence registered after 12 months (6.5%), confirms the importance of manometry and rehabilitation, both necessary to improve the quality of life in old patients who undergo low anterior resection.

In this study 8 pancreatic resections were performed using the Autosuture stapler. No fistula developed among 5 cases of distal pancreatectomy, conversely 2 pancreatic fistula occurred in 3 cases of pancreaticoduodenectomy; one patient died for fistula. It is concluded that distal pancreatectomy with staplers is a reasonable and safe alternative to pancreaticojejunostomy, and may be preferred because of its facility and rapidity. Staple closure of the transected pancreas in pancreaticoduodenectomy doesn't seem to be so safe and further evaluation is needed.