الفهرس 
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Abstract
This study is a randomized controlled study carried out in department of general surgery in Menoufia and Aswan teaching hospital.
Started from Decemoer 2015 up to Decemper 2017. It includes
40 patients 20 of them treated by handswen suture method (group A)
and other (group B) include 20 patients in whom small intestinal
anastomosis was done by Stapling technique.
-Included elective cases; carcinoma of small intestine, carcinoid tumour
of small intestine, leiomyoma of small intestine and lymphoma of small intestine.
- Included urgent cases; strangulated small intestine, penetrating injurg to the small intestine and mesenteric vascular occlusion.
- Excluded cases; children less than 12 years of age, old patients above 70 years, disseminated malignancy, gangrenous small intestine and immunosuppressed patients.
- Open surgery was applied in all the cases.
- End to end anastomosis was applied in all the cases.
- In handswen anastomosis we used the two layerd anastomosis consists of inner layer of continuous sutures and outer Lumbert interrupted seromuscular sutures using Vicryl 3/0 on rounded needel.
- In stapler technique we used the linear cutter stapler 60 with blue cartridge color.
- Patients operated by stapler technique had shorter anastomosis time, early return of bowel sounds, begin oral intake earlier, less postoperative complications and discharged early from the hospital comparing to patients operated by handswen method.
-In urgent cases the risk of anastmotic leak was equivalent when comparing handswen and Stapler anastomosis.
-The evaluation of mechanical sutures by mean of Stapler use has become a real technological advancement process, as it has representes the concept of a new product with the combination of new function that have resulted in improvement and effective gains of quality or productivity in the handicraft suture process.
Many surgeons now consider the stapling technique as best alternate method of anastomosis to the suture technique for: 1- Speed.
2- Safty.
3-Efficiency.
4- Reach difficult sites of anastomosis.
-A number of benefites conferred by the use of stapling instruments such as:
1-Minimizing tissue manipulation
2- Minimizing tissue trauma.
3- Less bleeding at the site of anastomosis.
4- Less edema at the site of anastomosis.
5- Quick return of gastrointestinal function.
6- More rapid patient recovery.
-Handswen technique is better applied in:
1- Disparity in the lumen.
2- Laceration of the edge.
3- Contamination and sepsis.