Journal of Gastrointestinal Surgery

, Volume 15, Issue 5, pp 876–884 | Cite as

Hand-Sewn Versus Stapled Oesophago-gastric Anastomosis: Systematic Review and Meta-analysis

  • Sheraz R. Markar
  • Alan Karthikesalingam
  • Soumil Vyas
  • Majid Hashemi
  • Mark Winslet
Review Article



In this meta-analysis, data from relevant randomised controlled trials has been pooled together to gain a consensus in the comparison of outcome following hand-sewn versus stapled oesophago-gastric (OG) anastomoses.


Medline, Embase, Cochrane, trial registries, conference proceedings and reference lists were searched for randomised controlled trials comparing hand-sewn and stapled OG anastomoses. Primary outcome measures were 30-day mortality, anastomotic leakage and stricture. Secondary outcomes were operative time, cardiac complications and pulmonary complications.


Nine randomised trials were included in this meta-analysis. There was no significant difference between the groups for 30-day mortality (pooled odds ratio = 1.71; 95% CI = 0.822 to 3.56; P = 0.15) and anastomotic leakage (pooled odds ratio = 1.06; 95% CI = 0.62 to 1.80; P = 0.83). There was a significantly increased rate of anastomotic stricture associated with stapled OG anastomosis (pooled odds ratio = 1.76; 95% CI = 1.09 to 2.86; P = 0.02).


Meta-analysis of randomised controlled trials comparing hand-sewn with stapled OG anastomosis demonstrates that a stapled anastomosis is associated with a shorter operative time but with an increased rate of post-operative anastomotic stricture.


Sutured Stapled Anastomosis Oesophageal Gastric 




Conflict of Interest



  1. 1.
    Maillard JN, Launois B, De Lagausie P, Lellouch JP, Lortat-Jacob JL. Cause of leakage at the site of anastomosis after esophagogastric resection for carcinoma. Surg Gynecol Obstet 1969;139:1014–8Google Scholar
  2. 2.
    Earlam R, Cunha-Mela JR. Oesophageal squamous cell carcinoma: a critical review of surgery. Br J Surg 1980;67:381–90PubMedCrossRefGoogle Scholar
  3. 3.
    Muller JM, Zieren U, Wolters U, Pichlmaier H. Results of esophagectomy and gastric bypass for cancer of the oesophagus. Hepatogastoenterology 1989;36:552–8Google Scholar
  4. 4.
    Goldmine M, Maddern G, Le Prise E, Meunier B, Campion JP, Launois B. Esophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial. Br J Surg 1993;80:367–70CrossRefGoogle Scholar
  5. 5.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1–12PubMedCrossRefGoogle Scholar
  6. 6.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986 7: 177–188PubMedCrossRefGoogle Scholar
  7. 7.
    Law S, Fok M, Chu KM, Wong J. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg 1997 Aug;226(2):169–73PubMedCrossRefGoogle Scholar
  8. 8.
    Hsu HH, Chen Js, Huang PM, Lee JM, Lee YC. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg. 2004 Jun;25(6): 1097–101PubMedCrossRefGoogle Scholar
  9. 9.
    Laterza E, de’Manzoni G, Veraldi GF, Guglielmi A, Tedesco P, Cordiano C. Manual compared with mechanical cervical oesophagogastric anastomosis: a randomised trial. Eur J Surg 1999 Nov; 165(11): 1051–4PubMedCrossRefGoogle Scholar
  10. 10.
    Valverde A, Hay JM, Fingerhut A, Elhadad A. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research. Surgery 1996 Sep:120(3):476–83PubMedCrossRefGoogle Scholar
  11. 11.
    Luechakiettisak P, Kasetsunthom S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study. J Med Assoc Thai 2008 May: 91(5):681–5PubMedGoogle Scholar
  12. 12.
    Walther B, Johansson J, Johnsson F, Von Holstein CS, Ziling T. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg 2003 Dec:238(6):803–12PubMedCrossRefGoogle Scholar
  13. 13.
    Okuyama M, Motoyama S, Suzuki H, Saito R, Maruyama K, Ogawa J. Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled study. Surg Today 2007;37(11):947–52PubMedCrossRefGoogle Scholar
  14. 14.
    Craig SR, Walker WS, Cameron EW, Wightman AJ. A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb 1996 Feb;41(1):17–9PubMedGoogle Scholar
  15. 15.
    W.D. George. West of Scotland and Highland Anastomosis Study Group. Suturing or stapling in gastrointestinal surgery: a prospective randomize study. Br J Surg 1991 Mar; 78: 337–341CrossRefGoogle Scholar
  16. 16.
    Beitler A, Urschel JD. Comparison of stapled and hand-sewn esophagogastric anastomoses. Am J Surg. 1998;175:337–340PubMedCrossRefGoogle Scholar
  17. 17.
    Urschel JD, Blewett CJ, Bennet WF, Miller JD, Young JEM. Hand-sewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Diseases of Esophagus (2001);14:212–217PubMedCrossRefGoogle Scholar
  18. 18.
    The French Association for Surgical Research, Fingerhut A, Elhadad A, Hay JM, Lacaine F, Flamant Y. Infraperitoneal colocrectal anastomosis: hand-sewn vs circular staples. A controlled clinical trial. Surgery 1994; 116:484–90PubMedGoogle Scholar
  19. 19.
    Muchrcke DD, Kaplan DK, Donnely RJ. Anastomotic narrowing after esogastrectomy with the EEA stapling device. J Thorac Cardiovasc Surg 1989; 97:434–8.Google Scholar
  20. 20.
    Wong J, Cheung H, Lui R, Fan YW, Smith A, Siu KF. Esophago-gastric anastomosis performed with a stapler: the occurrence of leakage and stricture. Surgery 1987;101:408–15PubMedGoogle Scholar
  21. 21.
    Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie AE. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Databse Syst Rev. 2007 18;(3):CD004320Google Scholar
  22. 22.
    Shope TR, Cooney RN, McLeod J, Miller CA, Haluck RS. Early results after laparoscopic gastric bypass: EEA vs. GIA stapled gastrojejunal anastomosis. Obes Surg 2003; 13(3): 355–9PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher BL, Atkinson JD, Cottam D. Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study. Surg Obes Relat Dis. 2007; 3(2): 176–9PubMedCrossRefGoogle Scholar
  24. 24.
    Ng T, Vezeridis MP. Advances in the Surgical Treatment of Esophageal Cancer. J Surg Onc 2010; 101: 725–729CrossRefGoogle Scholar
  25. 25.
    Lerut T, Coosemans W, De Leyn P, Decker G, Deneffe G, Van Raemdonck D. Is there a role for radical esophagectomy. Eur J Cardiothorac Surg 16 (Suppl 1) (1999): S44–S47PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Sheraz R. Markar
    • 1
  • Alan Karthikesalingam
    • 2
  • Soumil Vyas
    • 1
  • Majid Hashemi
    • 1
  • Mark Winslet
    • 1
    • 3
  1. 1.Department of General SurgeryUniversity College London HospitalLondonUK
  2. 2.Department of General SurgeryChelsea and Westminster NHS Foundation TrustLondonUK
  3. 3.Department of General SurgeryRoyal Free Hampstead HospitalLondonUK

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