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Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials

  • Systematic Review and Meta-analysis
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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aims of this study are to compare the 30-day rate of bowel obstruction for stapled vs. handsewn closure of loop ileostomy, and to further assess efficacy and safety for each technique by secondary endpoints such as operative time, rates of anastomotic leakage, and other post-operative complications within 30 days.

Methods

A systematic literature search (MEDLINE, The Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomized controlled trials (RCTs) comparing stapled and handsewn closure of loop ileostomy after low anterior resection. Random effects meta-analyses were calculated and presented as risk ratio (RR) and mean difference (MD) with corresponding 95 % confidence intervals.

Results

Forty publications were retrieved and 4 RCTs (649 patients) were included. There was methodological and clinical heterogeneity of included trials, but statistical heterogeneity was low for most endpoints. Stapler use significantly reduced the rate of bowel obstruction compared to hand-sewn closure (RR 0.53 [0.32, 0.88]; P = 0.01). The operation time was significantly lower for stapling compared to hand suture (MD −15.5 min [−18.4, 12.6]; P < 0.001). All other secondary outcomes did not show significant differences.

Conclusions

This meta-analysis shows superiority of stapled closure of loop ileostomy compared to handsewn closure in terms of bowel obstruction rate and mean operation time. Other relevant complications such as anastomotic leakage are equivalent. Even so, both techniques are options with opposing advantages and disadvantages.

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Acknowledgments

Special Thanks go to Katrin Jensen, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany and Kathrin Grummich, Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany, who supported the literature search process, edit of the final manuscript, and statistical analysis.

Conflicts of interest

None.

Authors’ contributions

T. Löffler and I Rossion conceptualized the study and design. T. Löffler, I. Rossion, and K. Gooßen acquired the data. D. Saure, M. Diener, K. Gooßen, J. Weitz, A. Ulrich, and M. Büchler analyzed and interpreted the data. T. Löffler, M. Diener, K. Gooßen, and D. Saure drafted the manuscript. I. Rossion, J. Weitz, A. Ulrich, and M. Büchler critically revised the manuscript.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Thorsten Löffler, Alexis Ulrich, Markus W. Büchler & Markus K. Diener

  2. Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany

    Thorsten Löffler, Inga Rossion, Käthe Gooßen, Markus W. Büchler & Markus K. Diener

  3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Daniel Saure

  4. Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany

    Jürgen Weitz

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Appendix

Appendix

Table 5 Search strategy in MEDLINE
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Table 6 List of retrieved studies
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Table 7 Quality assessment
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Löffler, T., Rossion, I., Gooßen, K. et al. Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg 400, 193–205 (2015). https://doi.org/10.1007/s00423-014-1265-8

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  • DOI: https://doi.org/10.1007/s00423-014-1265-8

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