Skip to main content
SpringerLink
Log in

Stapled Side-to-Side Anastomosis Might Be Better Than Handsewn End-to-End Anastomosis in Ileocolic Resection for Crohn’s Disease: A Meta-Analysis

  • Review
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Ileocolic anastomosis is an essential step in the treatment to restore continuity of the gastrointestinal tract following ileocolic resection in patients with Crohn’s disease (CD). However, the association between anastomotic type and surgical outcome is controversial.

Aims

The aim of this meta-analysis is to compare surgical outcomes between stapled side-to-side anastomosis (SSSA) and handsewn end-to-end anastomosis (HEEA) after ileocolic resection in patients with CD.

Methods

Studies comparing SSSA with HEEA after ileocolic resection in patients with CD were identified in PubMed and EMBASE. Outcomes such as complication, recurrence, and re-operation were evaluated. Eight studies (three randomized controlled trials, one prospective non-randomized trial, and four non-randomized retrospective trials) comparing SSSA (396 cases) and HEEA (425 cases) were included.

Results

As compared with HEEA, SSSA was superior in terms of overall postoperative complications [odds ratio (OR), 0.54; 95 % confidence interval (CI) 0.32–0.93], anastomotic leak (OR 0.45; 95 % CI 0.20–1.00), recurrence (OR 0.20; 95 % CI 0.07–0.55), and re-operation for recurrence (OR 0.18; 95 % CI 0.07–0.45). Postoperative hospital stay, mortality, and complications other than anastomotic leak were comparable.

Conclusion

Based on the results of our meta-analysis, SSSA would appear to be the preferred procedure after ileocolic resection for CD, with reduced overall postoperative complications, especially anastomotic leak, and a decreased recurrence and re-operation rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–1794.

    Article  PubMed  Google Scholar 

  2. Galandiuk S, Kimberling J, Al-Mishlab TG, Stromberg AJ. Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg. 2005;241:796–802.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Cosnes J. Crohn’s disease phenotype, prognosis, and long-term complications: what to expect? Acta Gastroenterol Belg. 2008;71:303–307.

    PubMed  Google Scholar 

  4. Choy PY, Bissett IP, Docherty JG, et al. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2007;(3):CD0043202011.

  5. Myrelid P, Soderholm JD, Olaison G, Sjodahl R, Andersson P. Split stoma in resectional surgery of high-risk patients with ileocolonic Crohn’s disease. Colorectal Dis. 2012;14:188–193.

    Article  CAS  PubMed  Google Scholar 

  6. Michelassi F, Upadhyay GA. Side-to-side isoperistaltic strictureplasty in the treatment of extensive Crohn’s disease. J Surg Res. 2004;117:71–78.

    Article  PubMed  Google Scholar 

  7. Buisson A, Chevaux JB, Allen PB, Bommelaer G, Peyrin-Biroulet L. Review article: the natural history of postoperative Crohn’s disease recurrence. Aliment Pharmacol Ther. 2012;35:625–633.

    Article  CAS  PubMed  Google Scholar 

  8. Watanabe T, Sasaki I, Sugita A, et al. Time trend and risk factors for reoperation in Crohn’s disease in Japan. Hepatogastroenterology. 2012;59:1081–1086.

    PubMed  Google Scholar 

  9. Gao X, Yang RP, Chen MH, et al. Risk factors for surgery and postoperative recurrence: analysis of a south China cohort with Crohn’s disease. Scand J Gastroenterol. 2012;47:1181–1191.

    Article  PubMed  Google Scholar 

  10. Li Y, Zhu W, Zuo L, et al. Frequency and risk factors of postoperative recurrence of Crohn’s disease after intestinal resection in the Chinese population. J Gastrointest Surg. 2012;16:1539–1547.

    Article  PubMed  Google Scholar 

  11. Ikeuchi H, Kusunoki M, Yamamura T. Long-term results of stapled and hand-sewn anastomoses in patients with Crohn’s disease. Dig Surg. 2000;17:493–496.

    Article  CAS  PubMed  Google Scholar 

  12. Mcleod RS, Wolff BG, Ross S, Parkes R, Mckenzie M. Recurrence of Crohn’s disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum. 2009;52:919–927.

    Article  PubMed  Google Scholar 

  13. Simillis C, Purkayastha S, Yamamoto T, et al. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum. 2007;50:1674–1687.

    Article  PubMed  Google Scholar 

  14. Guo Z, Li Y, Zhu W, et al. Comparing outcomes between side-to-side anastomosis and other anastomotic configurations after intestinal resection for patients with Crohn’s disease: a meta-analysis. World J Surg. 2013;37:893–901.

    Article  PubMed  Google Scholar 

  15. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.

    Article  CAS  PubMed  Google Scholar 

  17. Stang A. Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–605.

    Article  PubMed  Google Scholar 

  18. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–1558.

    Article  PubMed  Google Scholar 

  19. Cameron JL, Hamilton SR, Coleman J, Sitzmann JV, Bayless TM. Patterns of ileal recurrence in Crohn’s disease. A prospective randomized study. Ann Surg. 1992;215:546–552.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Caprilli R, Corrao G, Taddei G, et al. Prognostic factors for postoperative recurrence of Crohn’s disease. Gruppo Italiano per lo Studio del Colon e del Retto (GISC). Dis Colon Rectum. 1996;39:335–341.

    Article  CAS  PubMed  Google Scholar 

  21. Kusunoki M, Ikeuchi H, Yanagi H, Shoji Y, Yamamura T. A comparison of stapled and hand-sewn anastomoses in Crohn’s disease. Dig Surg. 1998;15:679–682.

    Article  CAS  PubMed  Google Scholar 

  22. Hashemi M, Novell JR, Lewis AA. Side-to-side stapled anastomosis may delay recurrence in Crohn’s disease. Dis Colon Rectum. 1998;41:1293–1296.

    Article  CAS  PubMed  Google Scholar 

  23. Yamamoto T, Keighley MR. Stapled functional end-to-end anastomosis in Crohn’s disease. Surg Today. 1999;29:679–681.

    Article  CAS  PubMed  Google Scholar 

  24. 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. Scand J Gastroenterol. 1999;34:708–713.

    Article  CAS  PubMed  Google Scholar 

  25. Yamamoto T, Allan RN, Keighley MR. Strategy for surgical management of ileocolonic anastomotic recurrence in Crohn’s disease. World J Surg. 1999;23:1055–1061.

    Article  CAS  PubMed  Google Scholar 

  26. Frieri G, Pimpo MT, Palumbo G, et al. Anastomotic configuration and mucosal 5-aminosalicyclic acid (5-ASA) concentrations in patients with Crohn’s disease: a GISC study. Gruppo Italiano per lo Studio del Colon e del Retto. Am J Gastroenterol. 2000;95:1486–1490.

    Article  CAS  PubMed  Google Scholar 

  27. Muñoz-Juárez M, Yamamoto T, Wolff BG, Keighley MR. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum. 2001;44:20–26.

    Article  PubMed  Google Scholar 

  28. Smedh K, Andersson M, Johansson H, Hagberg T. Preoperative management is more important than choice of sutured or stapled anastomosis in Crohn’s disease. Eur J Surg. 2002;168:154–157.

    Article  PubMed  Google Scholar 

  29. Tersigni R, Alessandroni L, Barreca M, Piovanello P, Prantera C. Does stapled functional end-to-end anastomosis affect recurrence of Crohn’s disease after ileocolonic resection? Hepatogastroenterology. 2003;50:1422–1425.

    PubMed  Google Scholar 

  30. Scarpa M, Angriman I, Barollo M, et al. Role of stapled and hand-sewn anastomoses in recurrence of Crohn’s disease. Hepatogastroenterology. 2004;51:1053–1057.

    PubMed  Google Scholar 

  31. Resegotti A, Astegiano M, Farina EC, et al. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn’s disease surgery. Dis Colon Rectum. 2005;48:464–468.

    Article  PubMed  Google Scholar 

  32. Scarpa M, Ruffolo C, Bertin E, et al. Surgical predictors of recurrence of Crohn’s disease after ileocolonic resection. Int J Colorectal Dis. 2007;22:1061–1069.

    Article  PubMed  Google Scholar 

  33. Zurbuchen U, Kroesen AJ, Knebel P, et al. Complications after end-to-end vs. side-to-side anastomosis in ileocecal Crohn’s disease-early postoperative results from a randomized controlled multi-center trial (ISRCTN-45665492). Langenbecks Arch Surg. 2013;398:467–474.

    Article  PubMed  Google Scholar 

  34. Scammell B, Ambrose NS, Alexander-Williams J, Allan RN, Keighley MR. Recurrent small bowel Crohn’s disease is more frequent after subtotal colectomy and ileorectal anastomosis than proctocolectomy. Dis Colon Rectum. 1985;28:770–771.

    Article  CAS  PubMed  Google Scholar 

  35. Farmer RG, Hawk WA, Turnbull RJ. Clinical patterns in Crohn’s disease: a statistical study of 615 cases. Gastroenterology. 1975;68:627–635.

    CAS  PubMed  Google Scholar 

  36. Fichera A, Zoccali M, Kono T. Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis. J Gastrointest Surg. 2012;16:1412–1416.

    Article  PubMed  Google Scholar 

  37. Kono T, Ashida T, Ebisawa Y, et al. A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn’s disease. Dis Colon Rectum. 2011;54:586–592.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, People’s Republic of China

    Xiaosheng He, Zexian Chen, Lei Lian, Santosh Rouniyar, Xiaojian Wu & Ping Lan

  2. Department of Geriatric, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China

    Juanni Huang

Authors
  1. Xiaosheng He
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zexian Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juanni Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lei Lian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Santosh Rouniyar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaojian Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ping Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ping Lan.

Additional information

Xiaosheng He and Zexian Chen have contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 119 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

He, X., Chen, Z., Huang, J. et al. Stapled Side-to-Side Anastomosis Might Be Better Than Handsewn End-to-End Anastomosis in Ileocolic Resection for Crohn’s Disease: A Meta-Analysis. Dig Dis Sci 59, 1544–1551 (2014). https://doi.org/10.1007/s10620-014-3039-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3039-0

Keywords

Search

Navigation