5/22/2023 0 Comments Stapled anastomosis![]() The studies in Crohn's disease were more recent but the combined number of patients was too small to summarise outcomes. The trials included in this review were performed from the early 1980's to 2009 involving six countries. This review did not compare different sewing materials or methods. Possible explanations include less handling of the bowel, decreased spillage of bowel content during surgery, and uniform closure of all the staples using a stapler. The reason why a handsewn bowel join is more likely to leak is unclear. Overall, there was no significant difference in the other outcomes of stricture, bleeding from the join, time to perform the join, re‐operation, mortality, intra‐abdominal abscess, wound infection and length of stay, although these were not consistently reported. This sub‐group included patients with Crohn's disease. For the sub‐group of 264 non‐cancer patients in three studies, there were no differences for the reported outcomes. For the sub‐group of 825 cancer patients in four studies, stapled join again has fewer leaks compared with handsewn, being 1.3% and 6.7% respectively. The leak rate from the bowel join for stapled anastomosis was 2.5%, significantly lower than handsewn (6%). This systematic review found seven randomised controlled trials with a total of 1125 participants (441 stapled, 684 handsewn) comparing these two methods. The join, or anastomosis, can be made by stapling or sewing. Surgery for right‐sided bowel cancer or Crohn's disease commonly involve removing a segment of bowel and re‐joining the small and large bowel together. Stapled functional end to end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis.Ī comparison of two methods to join small and large bowel together in surgery All other outcomes: stricture, anastomotic haemorrhage, anastomotic time, re‐operation, mortality, intra‐abdominal abscess, wound infection, length of stay, showed no significant difference. In subgroup analysis of non‐cancer patients (3 studies, 264 patients) there were no differences for any reported outcomes. For the sub‐group of 825 cancer patients in four studies, stapled anastomosis led to significantly fewer anastomotic leaks (S=4/300, HS=35/525, OR 0.28 p=0.01). One study performed routine radiology to detect asymptomatic leaks. Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with handsewn (S=11/441, HS=42/684, OR 0.48 p=0.03). The five largest trials had adequate allocation concealment. Main resultsĪfter obtaining individual data from authors for studies that include other anastomoses, seven trials (including one unpublished) with 1125 ileocolic participants (441 stapled, 684 handsewn) were included. Sub‐group analyses for cancer inflammatory bowel disease as indication for ileocolic anastomoses were performed. RevMan 5 was used to perform meta‐analysis when there were sufficient data. Relevant results were extracted and missing data sought from the authors. Data collection and analysisĮligible studies were selected and their methodological quality assessed. Randomised controlled trials comparing use of linear cutter stapler (isoperistaltic side to side or functional end to end) with any type of suturing technique in adults. Abstracts presented to the following society meetings between 19 were handsearched: American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, European Association of Coloproctology. MEDLINE, EMBASE, Cochrane Colorectal Cancer Group specialised register SR‐COLOCA, Cochrane Library were searched for randomised controlled trials comparing use of a linear cuter stapler with any type of suturing technique for ileocolic anastomoses in adults from 1970 to 2005 and were updated in December 2010. The hypothesis tested was that the stapling technique is associated with fewer complications. To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. This is an update of a Cochrane review first published in 2007. Individual trials comparing stapled versus handsewn ileocolic anastomoses have found little difference in the complication rate but they have lacked adequate power to detect potential small difference. The anastomosis may be constructed using a linear cutter stapler or by suturing. Ileocolic anastomoses are commonly performed for right‐sided colon cancer and Crohn's disease.
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