***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 controlled evaluation of a single‐layer everting technique of suture versus a conventional two‐layer inverting technique has been attempted in clinical large‐bowel surgery . Thirty‐five patients suffering from carcinoma or other diseases of the large intestine were allocated r and omly to each technique in the conduct of various forms of colonic resection with anastomosis or closure of a transverse colostomy . There were 3 operative deaths after everting suture and 1 after inverting suture , all attributable mainly to anastomotic failure . A higher proportion of patients developed wound infection or peritonitis after everting than inverting suture—51 as against 35 per cent . Overt faecal fistulation was observed in no less than 43 per cent of the patients having everting suture , but in only 8·6 per cent of those treated by inverting suture .  Late stricture formation was noted in 2 cases after everting suture , but in none after inverting suture BACKGROUND AND AIMS Sphincter-saving procedures for resection of mid and , in some cases , of distal rectal tumors have become prevalent as their safety have been established . Increased anastomotic leak rate , associated with the type of anastomosis and the distance from the anal verge , has been reported . To compare surgical outcomes of end-to-end and end-to-side anastomosis after anterior resection for T1-T2 rectal cancer . METHODS During the study period , a total of 298 rectal cancer patients were treated . Patients with T1-T2 rectal cancer ( i.e. , tumor level < or = 15 cm from the anal verge ) fit for surgery were asked to participate in the study . Patients were r and omized to receive either an end-to-end anastomosis or an end-to-side anastomosis using the left colon . Surgical results and complications were recorded . RESULTS Seventy-seven patients were r and omized . Thirty-seven end-to-end anastomoses and 40 end-to-side anastomoses were performed . Anastomotic leakage after end-to-end anastomosis was 29.2 % , while after end-to-side anastomosis was 5 % ( P = 0.005 ) . In the end-to-end group 11 patients had anastomotic leaks : nine patients needed a re-intervention with colostomy creation subsequently closed in seven cases . Two patients of the end-to-side group experienced anastomotic leakage and were successfully treated conservatively . CONCLUSIONS Regarding postoperative surgical complications , end-to-side anastomosis is a safe procedure Abstract . This study represents a European prospect i ve clinical multicenter trial and was undertaken to evaluate the applicability of the biofragmentable anastomosis ring ( BAR ) as a routine anastomotic tool in teaching hospitals . The trial results analyzed consisted of  1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper ( 1042 anastomoses ) and lower ( 624 anastomoses ) gastrointestinal ( GI ) tract . Only patients selected for elective procedures and having previously undergone ortho grade bowel cleansing were entered into the trial . In the upper GI tract six anastomoses ( 0.58 % ) developed clinical ly relevant and radiologically detectable leaks with indications for reoperation . In the lower GI tract 42 ( 6.73 % ) anastomoses showed a radiologically detectable leak with clinical manifestations in 28 cases ( 4.48 % ) . Reoperation was performed in 18 cases ( 2.80 % ) . The overall leakage rate with clinical relevance was 2.04 % . Three gastrojejunostomy episodes of bleeding were observed ( 0.18 % ) at the BAR anastomotic site . During the early postoperative course there was no ileus due to obstruction of a BAR anastomosis . Re introduction of diet after the operation was not delayed . In two centers a follow-up evaluation reported no BAR-related late anastomotic stenoses . There were no intraoperative deaths , but 54 patients died postoperatively . Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases ; three of them were related to BAR anastomoses . In conclusion , the BAR anastomotic procedure is an established , rapid , simple to learn , highly st and ardized , safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of stenosis . At present , the application of anastomoses in various segments of the GI tract , from the stomach to the middle third of the rectum , can be recommended 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 OBJECTIVE To find out if there were any differences in postoperative complications and anastomotic leak rate between sutured and stapled anastomoses after bowel resection in patients exposed to the same preoperative management programme . DESIGN Prospect i ve observational non-r and omised study . SETTING Colorectal unit , Sweden . PATIENTS Between 1996 and 2000 bowel resections with anastomosis were done for 42 consecutive patients with Crohn 's disease . 20 patients had their anastomoses sutured ( sutured group ) and 22 had their anastomosis stapled ( stapled group ) over two successive periods . MAIN OUTCOME MEASURES Postoperative complications and anastomotic leak rate . RESULTS None of the patients were on immunosuppressive treatment and about half in each group had had several weeks of preoperative enteral nutrition . No anastomotic-related complications and few other postoperative complications were noted , irrespective of the anastomotic technique used . CONCLUSION A strategy to operate on Crohn patients without steroids and , if indicated , treated preoperatively with enteral nutrition and percutaneous drainage of abscesses result ed in no anastomotic leaks and few postoperative complications . These results were independent of the anastomotic technique used INTRODUCTION Although intestinal anastomoses are mainly made by staplers , manual anastomoses are still in use worldwide . In previous studies , single layer anastomosis has shown better results compared to double layer techniques . PURPOSE To test experimentally some aspects of three different single layer anastomotic techniques in order to identify advantages and disadvantages of each . MATERIAL AND METHODS The study was done on Sprague Dawley rats . Animals were r and omly divided into four groups . Three experimental groups consisted of 21 animals each , and the fourth sham group contained 10 animals . By 7 animals of each group were sacrificed on the 4th and the rest of 14 animals on the 7th postoperative day . In all groups the resected distal part of the colon was anastomosed using Halsted , Gambee and Gambee-Halsted technique . To evaluate each specific technique the following were used : postoperative complication frequency , biomechanical measurements , adhesion density , condition of intestinal lumen and histological parameters of the healing process . RESULTS The complication frequency was not significantly different between the tested techniques . The average bursting pressure and tensile strength were higher on both the 4th and 7th postoperative days with the Gambee technique . In the colon segments removed on the 4th postoperative day 97 % of pressure induced ruptures occurred in the anastomotic line , whereas on the 7th postoperative day 76 % of ruptures occurred about 1 cm distal to the anastomotic line . CONCLUSION The Gambee technique had significantly better biomechanical and histological results compare to the other two anastomotic techniques . Adhesion density was significantly lower in the control group ( p<0.001 ) 272 patients underwent r and omly 133 h and sewn anastomosis and 139 stapled anastomosis ( 159 proximal and 119 distal ) after elective colorectal resection for 194 carcinomas , and 78 sigmoid diverticulosis and benign tumors . Both groups were comparable with regard to mortality ( 3.3 p. cent ) , wound abcesses ( 3 p. cent ) extra abdominal post operative complications ( 20 p. cent ) . There were however more reoperations in the stapled group ( 10 versus 6 ) , and also more low intestinal anastomotic bleeding ( 9 versus 5 ) . Stapled anastomosis were associated with less clinical fistulas ( 8 p. cent versus 12 p. cent ) and only after low colorectal anastomosis ( 9 p. cent versus 20 p. cent ) . Stapling devices decrease the duration of the anastomosis by 8 mn , but this gained time does not influence the total duration of the operation . These advantages must be weighed against the risks inherent to their uses , mishaps ( 14 p. cent ) , hemorrhages ( 6.5 p. cent ) , strictures ( 8 p. cent ) , and their higher cost ( 15 times as much ) In a r and omized prospect i ve clinical trial one layer and two layer techniques have been compared in 92 patients undergoing colorectal anastomosis .  The results were assessed radiologically by barium studies on the tenth postoperative day . There was no significant difference in the incidence of anastomotic breakdown with either technique when the anastomosis was performed above the pelvic peritoneal reflection . When the anastomosis was situated below the pelvic peritoneum the incidence of dehiscence was significantly greater when a two layer technique was used BACKGROUND Although used widely for supraperitoneal anastomoses , circular stapled anastomoses have never been proved better than h and -sewn anastomoses . In the one prospect i ve controlled trial that studied these anastomoses specifically , the only significant difference found was that there were more clinical ly obvious leakages with the circular stapled variety , but not in the overall clinical and roentgenologic leakage rates . METHODS One hundred fifty-nine consecutive patients ( 88 men and 71 women , mean age 65.8 + /- 12.1 years ) were r and omized to undergo  h and -sewn ( n = 74 ) or circular stapled ( n = 85 ) supraperitoneal colorectal anastomosis after left colectomy .  RESULTS Patient demographics were similar in both groups .  Overall mortality was 1.3 % ( 2 of 159 ; one in each group ) . No statistically significant difference ( NS ) was found in the rate of early complications , including anastomotic leakage ( 4 of 74 versus 6 of 85 ) in the h and -sewn and stapled anastomoses , respectively ) . Mishaps ( n = 10 ) and hemorrhage ( n = 5 ) occurred in the stapled group only . Stapled anastomoses took an average of 8 minutes less to perform ( p < 0.001 ) , but this time gain did not significantly influence the overall duration of operation ( identical median times ) . The median duration of hospitalization was 13 and 14 days , respectively ( NS ) . At 8 months there were 2 of 74 strictures in the h and -sewn group and 4 of 85 strictures in the stapled group ( NS ) . CONCLUSIONS According to these results , there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal colorectal anastomosis Anastomotic leakage is a major complication of rectal cancer surgery . The aim of this study was to investigate risk factors associated with symptomatic anastomotic leakage after total mesorectal excision ( TME ) The aim of this retrospective non‐r and omized study was to evaluate the short‐term functional outcome following  elective resectional surgery for complicated sigmoid diverticular disease , and to compare results of patients having h and ‐sewn or stapled end‐to‐end colonic anastomosis to the proximal rectum The merits of stapled versus h and sewn anastomosis were evaluated in a prospect i ve r and omized study of 60 patients undergoing resection for rectal cancer . The analysed factors included the time required for construction of anastomosis , post operative complications , local recurrence , disease free state and survival .  H and sewn anastomosis was performed in two layers with 3/0 silk in 30 cases and the stapled anastomosis with EEA staplers in 30 cases . The anastomosis time averaged 24 minutes in the suture group and 16 minutes in the stapling group . Five post-operative complications occurred in each group . Six patients of the h and sewn group developed local recurrence as a first sign of treatment failure compared to four patients in the stapled group . 
    Output:
    
Results show that , for many aspects of the h and -sewn colorectal anastomosis technique , evidence is lacking .
A single-layer continuous technique using inverting sutures with slowly absorbable monofilament material seems preferable .
However , in contrast to stapled and compression colorectal anastomoses , the technique for h and -sewn colorectal anastomoses is nonst and ardized with regard to intersuture distance , suture distance to the anastomotic edge , and tension on the suture .