***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A r and omized trial was undertaken to compare the biofragmental anastomotic ring ( BAR ) with conventional intraperitoneal colorectal anastomotic techniques .  Patients were r and omized into one of two schemes : BAR versus sutured or BAR versus stapled anastomosis . There were 782 patients entered into the study and 283 patients ( 36 % ) had a sutured anastomosis , 104 patients ( 13 % ) had a stapled anastomosis  , and 395 ( 51 % ) had the BAR .  Comparison of the BAR with combined suture and stapled controls revealed no significant differences in wound complication , abscess rate , bleeding , anastomotic leaks , ileus , obstruction , or deaths . There were no differences in return of bowel function , return to normal diet , or hospital stay . Intraoperative difficulties occurred in 46 BAR patients ( 17 % ) , and this was significantly higher ( p less than 0.001 ) than for sutured ( 3 % ) but not for stapled anastomoses ( 11 % ) . The occurrence of these problems did not adversely effect the outcome . The data suggest that the BAR is a safe , satisfactory alternative to sutured or stapled colorectal anastomoses One hundred and forty patients were included in a prospect i ve , r and omized , multidepartmental study in order to compare four manual and on mechanical type of ileocolic anastomoses after right hemicolectomy for cancer . The study was design ed as a pragmatic trial as defined by Schwartd . The main criterion of assessment was the anastomotic dehiscence judged with clinical criteria or a systematic follow-through with Gastrograffine on the tenth day postoperatively . All groups were similar except for a lower incidence of intraoperative septic factors for the group treated with mechanical anastomoses . The results show that the mechanical anastomosis produces fewer anastomotic dehiscences than all the other procedures except the terminolateral anastomosis with separate stitches using a slow-absorption suture material . Although it is about ten times as expensive as manual anastomosis , we suggest performing a mechanical ileocolic anastomosis after right hemicolectomy for cancer or , failing that , a manual terminolateral anastomosis with separate stitches Eighty‐eight cancer patients with the presence of one or more adverse factors for healing ( carcinomatosis , adhesions , prior chemotherapy and radiation therapy , bowel obstruction , anemia , and low leukocyte count or albumin value ) were prospect ively r and omized to undergo conventional two‐layer h and suturing ( 45 patients ) or mechanical stapling with a GIA/TA instrument ( U. S. Surgical Corp. , Norwalk , CT ) ( 43 patients ) of the large or small bowel anastomosis . Age , sex , complete blood count findings , and all biochemical plasma values were comparable in both groups . The anastomosis took an average of 19 minutes for the sutured and 9 minutes for the stapled technique ( P = 0.0001 ) , but the average length of operation , postoperative return of bowel function , and hospital stay were comparable in both groups . Bowel fistula was seen in one case of stapled anastomosis ( P = not significant ) . The pulmonary and wound complication rates were the same in both groups . Of the four deaths ( 4.5 % ) due to causes unrelated to bowel anastomosis , three occurred in the stapled and one in the sutured group . It was concluded that a stapled anastomosis is as safe as a sutured one in patients with advanced‐stage cancer . It saves time in anastomosis , but does not save time in postoperative return of the bowel function and hospital stay Objective The authors compared both the initial and the long-term outcomes of patients undergoing stapled and sutured colorectal anastomoses .  Summary Background Data Summary Background Data and stapled large bowel anastomoses are perceived to be equally safe , but concern has been raised about increased rates of tumor recurrence with the use of stapling instruments . Methods The outcome of patients with sutured and stapled colorectal anastomoses  were compared in a prospect i ve , multicenter , r and omized study . Factors affecting long-term outcomes were assessed by both univariate and multivariate analysis . Results Results hundred thirty-two patients were recruited . There was a significant increase in radiologic leakage in the sutured group ( 14.4 % vs. 5.2 % , p < 0.05 ) , but there was no difference in clinical anastomotic leak rates , morbidity , or postoperative mortality . Tumor recurrence and cancer-specific mortality were higher in the sutured patients ( 7.5 % and 6.7 % , respectively ) and in patients with anastomotic leaks . Conclusions Conclusions study shows that suturing or stapling are equally safe in large bowel surgery . However , it also shows a long-term benefit of stapling in colorectal cancer patients BACKGROUND Although the use of stapling devices in elective colon surgery has been shown to be as safe as h and sewn techniques , there have been concerns about their safety in emergency trauma surgery . The purpose of this study was to compare stapled with h and sewn colonic anastomosis following penetrating trauma . METHODS This was a prospect i ve multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma . Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and h and sewn repairs . RESULTS Two hundred seven patients underwent colon resection and primary anastomosis .  In 128 patients ( 61.8 % ) the anastomosis was performed with h and sewing and in the remaining 79 ( 38.2 % ) with stapling devices . There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7 % ( 26.6 % in the stapled group and 20.3 % in the h and sewn group , p = 0.30 ) . The incidence of anastomotic leak was 6.3 % in the stapled group and 7.8 % in the h and sewn group ( p = 0.69 ) . Multivariate analysis adjusting for blood transfusions , fecal contamination , and type of antibiotic prophylaxis showed that the adjusted odds ratio ( OR ) of complications in the stapled group was 0.83 ( 95 % CI , 0.38 - 1.74 , p = 0.63 ) . In a second multivariate analysis adjusting for blood transfusions , hypotension , fecal contamination , Penetrating Abdominal Trauma Index , and preoperative delays the adjusted OR in the stapled group was 0.99 ( 95 % CI , 0.46 - 2.11 , p = 0.99 ) . CONCLUSION The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon 's preference PURPOSE : Preanastomotic recurrence and stricturing after surgery for ileocolic Crohn 's disease is a frequent , unexplained phenomena that may lead to prompt reoperation . The aim of this study was to determine whether a wide-lumen stapled anastomosis ( side-to-side , functional end-to-end ) provides better outcome than a conventional sutured end-to-end anastomosis METHOD : A case-control comparative analysis of patients with Crohn 's disease from two inflammatory bowel disease centers treated with wide-lumen stapled anastomosis and a matched ( age and gender ) group treated with conventional sutured end-to-end anastomosis was performed . RESULTS : A total of 138 patients with Crohn 's disease were treated , 69 with wide-lumen stapled anastomosis and 69 with conventional sutured end-to-end anastomosis .  Preoperative therapy , number of previous resections , indication for operation , and length of bowel resected were similar in both groups . Fewer complications occurred after wide-lumen stapled anastomosis ( P=0.048 ) . A total of 55 patients developed recurrent Crohn 's disease symptoms , 39 ( 57 percent ) in the conventional sutured end-to-end anastomosis and 16 ( 24 percent ) in the wide-lumen stapled anastomosis group . Median follow-up was 70 and 46 months , respectively . After conventional sutured end-to-end anastomosis 18 reoperations were required , 15 for anastomotic stricture and 3 for fistulization . After wide-lumen stapled anastomosis three reoperations were necessary , two for stricture and one for fistulization . The cumulative reoperation rate for anastomotic recurrence was significantly lower ( P=0.017 ; log-rank test ) for the wide-lumen stapled anastomosis group . CONCLUSION : Wide-lumen stapled anastomosis is as safe as conventional sutured end-to-end anastomosis and results in a lower incidence of symptomatic recurrent Crohn 's disease and need for reoperation . Further prospect i ve study of the wide-lumen stapled anastomosis technique is necessary to define the precise role of this operation in patients with Crohn 's disease A polyglycolic acid device has been design ed for the performance of sutureless colonic anastomoses . The use of this biofragmentable anastomosis ring ( BAR ) was compared with conventional techniques in a prospect i ve , r and omized study of 59 patients ( x age , 49 years ) undergoing ileocolostomy ( n = 23 ) or colocolostomy ( n = 36 ) . The anastomotic technique was determined at surgery by r and omization ( BAR , 27 patients ; suture , 16 patients ; staple , 16 patients ) . Performance of an  anastomosis  with the BAR required an average of 22 minutes , a stapled anastomosis required 33 minutes , and the suture technique required 37 minutes . Learning curve error contributed to the six intraoperative complications that occurred with performance of the anastomosis ( BAR , three ; end-to-end anastomosis [ EEA ] instrument , three ) . The two postoperative deaths were unrelated to the anastomosis . Length of hospitalization in uncomplicated patients was the same among the three groups . The 17 patients with prolonged hospitalization  had complications unrelated to anastomotic technique . All patients were followed for a minimum of 6 weeks ; no additional complications were identified . We concluded that 1 ) the BAR is a rapid , safe method for performance of sutureless anastomoses ; 2 ) perioperative mortality and morbidity rates of the BAR are comparable to conventional techniques of suture and staple ; and 3 ) long-term follow-up of BAR patients is warranted to determine the incidence of complications , such as structure and /or stenosis A controlled prospect i ve study was carried out in a university-affiliated community hospital to evaluate the use of gastrointestinal staples compared with conventional sutures for anastomotic construction . The study included 100 r and omized cases ( 50 sutured and 50 stapled ) requiring anastomoses . Consecutive patients were accepted into the study , and no patients were excluded . There was no significant difference between the two groups in operating room time or the duration of postoperative hospitalization , nasogastric intubation or intravenous intubation . The complication rate was similar and comparable to previously published results . On three occasions , it was necessary during operation to convert from the use of staples to sutures when immediate disruption was noted at a gastroduodenal anastomosis Aim : This study aim ed at determining the reoperation rates of patients with anastomoses for Crohn ’s disease . The outcome of patients undergoing stapled anastomoses was compared with that of patients having h and -sewn anastomoses . Methods : Sixty-three patients undergoing intestinal resection for Crohn ’s disease at our institution from 1987 to 1996 were studied in a prospect i ve , r and omized trial . The group undergoing stapling comprised 30 patients and 37 anastomoses . The group with a h and -sewn anastomosis comprised 33 patients and 45 anastomoses . The median follow-up period was 87 ( range 36–140 ) months . Results : There were no significant differences in operative indications or patients ’ age and sex between the groups . There was a significant difference in cumulative recurrences between the groups ( Cox-Mantel test : p = 0.022 ) . Conclusion : A stapled anastomosis after resection for Crohn ’s disease may delay reoperation in patients with symptomatic recurrence A prospect i ve r and omized study of 1004 patients is reported , comparing surgical stapling and manual suturing techniques in the construction of gastrointestinal anastomoses . The incidence of clinical leaks was similar between the two groups ( sutured 3·2 per cent , stapled 4·7 per cent ; P = 0·22 ) , while for radiological leaks the incidence was significantly higher in the sutured group ( 12·2 per cent versus 4·1 per cent , P<0·05 ) . Stapling instruments afforded significantly quicker anastomoses , mean(s.e.m . ) 28·1(0·7 ) versus 14·3(0·5 ) min ( P<0·001 ) , and quicker operations , 115·5(2·4 ) versus 103·8(2·2 ) min ( P < 0·001 ) . The two groups were found to be comparable in other respects such as operative mortality 
    Output:
    
Stapled functional end to end ileocolic anastomosis is associated with fewer leaks than h and sewn anastomosis