Exploring the Use of Skin Staples for Bowel Anastomosis: A Scoping Review

Document Type : Review Article

Authors

1 Department of Surgery, Afe Babalola University, Ado-Ekiti, Nigeria

2 Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri

3 Master student of Public Health, Rutgers School of Public Health, New Jersey, United States of America

10.30476/acrr.2025.106368.1243

Abstract

Background: Intestinal staplers have revolutionized gastrointestinal surgery by facilitating faster bowel 
anastomoses, achieving outcomes comparable to hand-sewn techniques. However, their high cost restricts 
routine use in resource-limited settings, leading to increased interest in using skin staples for bowel anastomoses. 
Therefore, we aim to evaluate the use of skin staples for this purpose.
 Methods: We conducted a systematic search of databases using the search terms “skin staples” and “bowel 
anastomoses.” Studies that focused on the use of skin staples for bowel anastomoses were included, while 
abstracts, animal studies, and conference papers were excluded. The risk of bias was assessed with the 
ROBINS-I tool.
 Results: Two non-randomized studies involving 115 patients met the inclusion criteria. The majority of cases 
involved small bowel-to-small bowel anastomoses (74.8%), with cancer being the primary indication (80%). 
Postoperative complications included two cases of pelvic collections and one case of intestinal obstruction, all 
of which were managed non-operatively. No anastomotic leaks were reported. The risk of bias was moderate 
due to unclear patient selection processes.
 Conclusion: While the use of skin staples for bowel anastomoses appears to be safe, with no reported 
anastomotic leaks and minimal complications in the included studies, it is important to note the small sample 
sizes of these studies. This highlights the need for further multicenter randomized controlled trials to validate 
these findings and compare outcomes with conventional staplers and hand-sewn methods. The potential of skin 
staples as a viable alternative in resource-limited settings is promising; however, further research is necessary 
to confirm this.

Highlights

Saburi Oyewale (Google Scholar)

Keywords


1. Steichen FM, Ravitch MM.
Mechanical sutures in surgery.
The British journal of surgery.
1973;60(3):191-7.
2. Kusunoki M, Ikeuchi H, Yanagi H,
Shoji Y, Yamamura T. A comparison
of stapled and hand-sewn anastomoses
in Crohn’s disease. Digestive surgery.
1998;15(6):679-82.
3. Yamamoto T, Bain IM, Mylonakis
E, Allan RN, Keighley MR. Stapled
functional end-to-end anastomosis
versus sutured end-to-end anastomosis
after ileocolonic resection in Crohn
disease. Scandinavian journal of
gastroenterology. 1999;34(7):708-13.
4. Abdelhady M AM, Hagag M, Nassar
M. Stapler versus handswen in small
intestinal anastomosis. Int Surg J
2018;14(5).
5. Adisa AO, Olasehinde O, Arowolo OA, Alatise OI, Agbakwuru EA.
Early Experience with Stapled
Gastrointestinal Anastomoses in a
Nigerian Hospital. Nigerian journal
of surgery : official publication of the
Nigerian Surgical Research Society.
2015;21(2):140-2.
6. A. M. Economic Growth for Poverty
Reduction in Africa: Recent History
and Current Issues. 12004.
7. Allen RC. Absolute Poverty:
When Necessity Displaces Desire
%J American Economic Review.
2017;107(12):3690–721.
8. El-Sayed AM, Vail D, Kruk ME.
Ineffective insurance in lower and
middle income countries is an obstacle
to universal health coverage. Journal
of global health. 2018;8(2):020402.
9. Howell GP, Ryan JM, Morgans BT,
Cooper GJ. Assessment of the use
of disposable skin staplers in bowel
anastomoses to reduce laparotomy
time in penetrating ballistic injury
to the abdomen. Annals of the Royal
College of Surgeons of England.
1991;73(2):87-90.
10. Wetherall AP, Howell GP. Assessment
of the use of disposable skin staplers to
reduce laparotomy time in penetrating
ballistic injury of the abdomen.
Annals of the Royal College of
Surgeons of England. 1992;74(3):228.
11. Fraser I. Intestinal anastomosis with
a skin stapler: a safe and efficient
method in humans. The British
journal of surgery. 1994;81(5):665-7.
12. van den Akker OR, Peters GY, Bakker
CJ, Carlsson R, Coles NA, Corker KS,
et al. Increasing the transparency
of systematic reviews: presenting
a generalized registration form.
Systematic reviews. 2023;12(1):170.
13. Page MJ MJ, Bossuyt PM, Boutron I,
Hoffmann TC, Mulrow CD, et al. The
PRISMA 2020 statement: an updated
guideline for reporting systematic
reviews. Bmj 2021;372.
14. Ouzzani M HH, Fedorowicz Z,
Elmagarmid A. Rayyan-a web and
mobile app for systematic reviews.
Syst Rev 2016;5(1):210.
15. Sterne JA, Hernán MA, Reeves BC,
Savović J, Berkman ND, Viswanathan
M, et al. ROBINS-I: a tool for assessing
risk of bias in non-randomised studies
of interventions. BMJ (Clinical
research ed). 2016;355:i4919.
16. McGuinness LA, Higgins JPT. Riskof-
bias VISualization (robvis): An
R package and Shiny web app for
visualizing risk-of-bias assessments.
Research synthesis methods.
2021;12(1):55-61.
17. Coney PM, Scott MA, Strachan JR.
Small bowel anastomosis with a skin
stapler: safe, cost-effective and easily
learnt in urological surgery. BJU
international. 2007;100(3):715-7.
18. McHele GM, Mwanga AH, Kitua
DW, Chugulu S. Preoperative waiting
time and outcomes of non-traumatic
emergency abdominal surgeries:
Insights from a zonal referral hospital
in northern Tanzania, a reference for
health centers with similar capacities.
Surgery in practice and science.
2023;14:100202.
19. Ho YH, Ashour MA. Techniques
for colorectal anastomosis. World
journal of gastroenterology.
2010;16(13):1610-21.
20. Schineis C, Fenzl T, Aschenbrenner
K, Lobbes L, Stroux A, Weixler B,
et al. Stapled intestinal anastomoses
are more cost effective than handsewn
anastomoses in a diagnosis
related group system. The surgeon
: journal of the Royal Colleges of
Surgeons of Edinburgh and Ireland.
2021;19(6):321-8.