Handsewn or stapled colorectal anastomosis? Or how evidence based is surgical practice?

Responding to increasing demands for costeffectiveness relation a recent randomized trial which compared the cost of stapled and handsutured anastomosis in the gastrointestinal tract, has concluded that stapled anastomosis are not efficcient and should be reserved for individual indications. 1 However, one can admit that in the general surgical practice, preference for stapler is so overwhelming that cost-effectiveness approach is being neglected since the first anastomotic machine has been fired. As a matter of fact most surgeons do not regard this as an issue of concern and as a result it has not been considered as a major study endpoint in the literature. 2