Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: sistematic review and meta-analysis

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

Paula Marcela Vilela Castro¹  Felipe Piccarone Gonçalves Ribeiro¹  Amanda De Freitas Rocha¹  Mônica Mazzurana¹  Guines Antunes Alvarez¹ 

关键词: Esophagectomy;    Surgical anastomosis;    Meta-analysis;    Esofagectomia;    Anastomose cirúrgica;    Metanálise;   

DOI  :  10.1590/S0102-67202014000300014

来源: SciELO

【 摘 要 】

INTRODUCTION: Postoperative anastomotic leak and stricture are dramatic events that cause increased morbidity and mortality, for this reason it's important to evaluate which is the best way to perform the anastomosis. AIM: To compare the techniques of manual (hand-sewn) and mechanic (stapler) esophagogastric anastomosis after resection of malignant neoplasm of esophagus, as the occurrence of anastomotic leak, anastomotic stricture, blood loss, cardiac and pulmonary complications, mortality and surgical time. METHODS: A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) using the combination of descriptors (anastomosis, surgical) and (esophagectomy) was performed. RESULTS: Thirteen randomized trials were included, totaling 1778 patients, 889 in the hand-sewn group and 889 in the stapler group. The stapler reduced bleeding (p <0.03) and operating time (p<0.00001) when compared to hand-sewn after esophageal resection. However, stapler increased the risk of anastomotic stricture (NNH=33), pulmonary complications (NNH=12) and mortality (NNH=33). There was no significant difference in relation to anastomotic leak (p=0.76) and cardiac complications (p=0.96). CONCLUSION: After resection of esophageal cancer, the use of stapler shown to reduce blood loss and surgical time, but increased the incidence of anastomotic stricture, pulmonary complications and mortality.

【 授权许可】

CC BY   
 All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License