Is hand sewing comparable with stapling for anastomotic leakage after esophagectomy? A meta-analysis

• Published in: World journal of gastroenterology : WJG 2014-12, Vol.20 (45), p.17218-17226
• Main Authors: Liu, Quan-Xing, Min, Jia-Xin, Deng, Xu-Feng, Dai, Ji-Gang
• Format: Article
• Language: English
• Subjects: Anastomotic; Anastomotic Leak - diagnosis; Anastomotic Leak - epidemiology; Anastomotic Leak - prevention & control; Chi-Square Distribution; Esophagectomy; Esophagectomy - adverse effects; Hand-sewn; Humans; Incidence; leakage; Meta-Analysis; Odds Ratio; Risk Factors; Surgical Stapling - adverse effects; suture; Suture Techniques - adverse effects; Treatment Outcome
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i45.17218

AIM:To compare the outcome of hand sewing and stapling for anastomotic leakage after esophagectomy.METHODS:A rigorous study protocol was established according to the recommendations of the Cochrane Collaboration.An electronic database search,hand search,and reference search were used to retrieve all randomized controlled trials that compared hand-sewn and mechanical esophagogastric anastomoses.RESULTS:This study included 15 randomized controlled trials with a total of 2337 patients.The results revealed that there was no significant difference in the incidence of anastomotic leakage between the methods[relative risk(RR)=0.77,95%confidence interval(CI):0.57-1.04;P=0.09],but a subgroup analysis yielded a significant difference for the sutured layer and year of publication(P s<0.05).There was also no significant difference in the incidence of postoperative mortality(RR=1.52,95%CI:0.97-2.40;P=0.07).However,the anastomotic strictures rate was increased in the stapler group compared with the hand-sewn group(RR=1.45,95%CI:1.11-1.91;P<0.01)in the end-to-side subgroup,while the incidence of anastomotic strictures was decreased(RR=0.34,95%CI:0.16-0.76;P<0.01)in the side-to-side subgroup.CONCLUSION:The stapler reduces the anastomotic leakage rate compared with hand sewing.End-to-side stapling increases the risk of anastomotic strictures,but side-to-side stapling decreases the risk.