Meta-Analysis
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World J Gastroenterol. Dec 7, 2014; 20(45): 17218-17226
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17218
Is hand sewing comparable with stapling for anastomotic leakage after esophagectomy? A meta-analysis
Quan-Xing Liu, Jia-Xin Min, Xu-Feng Deng, Ji-Gang Dai
Quan-Xing Liu, Jia-Xin Min, Xu-Feng Deng, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
Author contributions: Liu QX and Min JX contributed equally to this study; Min JX and Dai JG contributed substantially to conception and design of the study; Liu QX and Deng XF contributed to analysis and interpretation of all data and drafted the article; and Liu QX critically revised the article for important intellectual content.
Correspondence to: Ji-Gang Dai, MD, PhD, Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400037, China. 691057831@qq.com
Telephone: +86-23-68774724 Fax: +86-23-68774724
Received: July 11, 2014
Revised: August 24, 2014
Accepted: September 29, 2014
Published online: December 7, 2014
Processing time: 151 Days and 17.3 Hours
Abstract

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 (Ps < 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.

Keywords: Anastomotic leakage; Esophagectomy; Hand-sewn sutures; Mechanical sutures; Meta-analysis

Core tip: This was an important meta-analysis comparing the results of hand-sewn and stapling techniques for esophagogastric anastomosis after esophageal cancer resection. We performed some subgroup analyses that suggested some associations with anastomotic leakage: (1) the number of layers sutured (single or double); (2) year of publication (before 2003 vs 2003-2013); and (3) anastomotic sites (intrathoracic or cervical). A better understanding of this may yield a consensus for comparison of anastomotic leakage rate following the two methods of esophagogastric anastomosis after esophagogastrectomy for esophageal cancer.