Hand-Sewn Versus Stapled Oesophago-gastric Anastomosis: Systematic Review and Meta-analysis
- 414 Downloads
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.
KeywordsSutured Stapled Anastomosis Oesophageal Gastric
Conflict of Interest
- 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
- 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
- 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.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
- 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
- 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