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Intervention Review

Stapled versus handsewn methods for colorectal anastomosis surgery

  1. Delcio Matos1,*,
  2. Álvaro N Atallah2,
  3. Aldemar A Castro3,
  4. Suzana Angelica Silva Lustosa4

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 24 MAY 2001

DOI: 10.1002/14651858.CD003144

Database Title

Additional Information

How to Cite

Matos D, Atallah ÁN, Castro AA, Silva Lustosa SA. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD003144. DOI: 10.1002/14651858.CD003144.

Author Information

  1. 1

    Universidade Federal de São Paulo, Brazilian Cochrane Centre, São Paulo, São Paulo, Brazil

  2. 2

    Universidade Federal de São Paulo / Escola Paulista de Medicina, Brazilian Cochrane Centre, São Paulo, SP, Brazil

  3. 3

    State University of Heath Science, Department of Public Health, Maceió, Alagoas, Brazil

  4. 4

    Universidade Federal de São Paulo / Escola Paulista de Medicina, Surgical Gastroenterology Department, Sao Paulo, RJ, Brazil

*Delcio Matos, Brazilian Cochrane Centre, Universidade Federal de São Paulo, Rua Napoleão de Barros, 620, São Paulo, São Paulo, 04024-002, Brazil. dmatos.dcir@epm.br.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Randomized controlled trials comparing stapled with handsewn colorectal anastomosis have not shown either technique to be superior, perhaps because individual studies lacked statistical power. A systematic review, with pooled analysis of results, might provide a more definitive answer.

Objectives

To compare the safety and effectiveness of stapled and handsewn colorectal anastomosis. The following primary hypothesis was tested: the stapled technique is more effective because it decreases the level of complications.

Search methods

The RCT register of the Cochrane Review Group was searched for any trial or reference to a relevant trial (published, in-press, or in progress). All publications were sought through computerised searches of EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and through letters to industrial companies and authors. There were no limits upon language, date, or other criteria.

Selection criteria

STUDIES: All randomized clinical trials (RCTs) in which stapled and handsewn colorectal anastomosis were compared. PARTICIPANTS: Adult patients submitted electively to colorectal anastomosis. INTERVENTIONS: Endoluminal circular stapler and handsewn colorectal anastomosis. OUTCOMES: a) Mortality b) Overall Anastomotic Dehiscence c) Clinical Anastomotic Dehiscence d) Radiological Anastomotic Dehiscence e) Stricture f) Anastomotic Haemorrhage g) Reoperation h) Wound Infection i) Anastomosis Duration j) Hospital Stay.

Data collection and analysis

Data were independently extracted by the two reviewers (SASL, DM) and cross-checked. The methodological quality of each trial was assessed by the same two reviewers. Details of the randomization (generation and concealment), blinding, whether an intention-to-treat analysis was done, and the number of patients lost to follow-up were recorded. The results of each RCT were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome. External validity was defined by characteristics of the participants, the interventions and the outcomes. The RCTs were stratified according to the level of colorectal anastomosis. The Risk Difference method (random effects model) and NNT for dichotomous outcomes measures and weighted mean difference for continuous outcomes measures, with the corresponding 95% confidence interval, were presented in this review. Statistical heterogeneity was evaluated by using funnel plot and chi-square testing.

Main results

Of the 1233 patients enrolled ( in 9 trials), 622 were treated with stapled, and 611 with manual, suture. The following main results were obtained:
a) Mortality: result based on 901 patients; Risk Difference - 0.6% Confidence Interval -2.8% to +1.6%.
b) Overall Dehiscence: result based on 1233 patients; Risk Difference 0.2%, 95% Confidence Interval -5.0% to +5.3%.
c) Clinical Anastomotic Dehiscence : result based on 1233 patients; Risk Difference -1.4%, 95% Confidence Interval -5.2 to +2.3%.
d) Radiological Anastomotic Dehiscence : result based on 825 patients; Risk Difference 1.2%, 95% Confidence Interval -4.8% to +7.3%.
e) Stricture: result based on 1042 patients; Risk Difference 4.6%, 95% Confidence Interval 1.2% to 8.1%. Number needed to treat 17, 95% confidence interval 12 to 31.
f) Anastomotic Hemorrhage: result based on 662 patients; Risk Difference 2.7%, 95% Confidence Interval - 0.1% to +5.5%.
g) Reoperation: result based on 544 patients; Risk Difference 3.9%, 95% Confidence Interval 0.3% to 7.4%.
h) Wound Infection: result based on 567 patients; Risk Difference 1.0%, 95% Confidence Interval -2.2% to +4.3%.
i) Anastomosis duration: result based on one study (159 patients); Weighted Mean Difference -7.6 minutes, 95% Confidence Interval -12.9 to -2.2 minutes.
j) Hospital Stay: result based on one study (159 patients), Weighted Mean Difference 2.0 days, 95% Confidence Interval -3.27 to +7.2 days.

Authors' conclusions

The evidence found was insuficient to demonstrate any superiority of stapled over handsewn techniques in colorectal anastomosis, regardless of the level of anastomosis.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

The evidence found was insufficient to demonstrate any superiority of stapled over handsewn techniques for colorectal anastomosis, independently of the level of anastomosis.

The review with nine randomised controlled trials (1233 patients, 622 were submitted to stapling and 611 to handsewing technique) has been performed comparing the safety and effectiveness of stapled versus handsewn colorectal anastomosis. Meta-analysis was performed using the risk difference and weighted mean difference with corresponding 95% confidence intervals. Outcome measures were mortality, anastomotic dehiscence, stricture, haemorrhage, re-operation, wound infection, anastomosis duration (time taken to perform anastomosis) and hospital stay. No significant statistical differences were found, except that stricture was more frequent with stapling ( p<0,05)and time taken to perform the anastomosis, which was longer with handsewn techniques.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

結直腸吻合手術的吻合器與手縫法

隨機對照試驗比較結直腸吻合手術的吻合器與手縫法,沒有顯示哪一個技術較優越,也許是因為個別研究缺乏統計影響力.系統的審查，匯總分析結果，可以提供更明確的答案.

目標

比較結直腸吻合手術吻合器與手縫法的安全性和有效性.對以下主要假設進行了測試:因為減少了併發症的層次,吻合器是更為有效的.

搜尋策略

Cochrane Review Group 登記的隨機對照試驗中搜查的任何試驗或參照有關審判(出版了,出版中，或進行中)。所有出版物都試圖通過電腦檢索的醫學文摘庫EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database，並通過信件，工業企業和作者。沒有語言，日期或其他標準限制。

選擇標準

研究：所有隨機臨床試驗比較結直腸吻合手術的吻合器與手縫法. 參與者:選擇結直腸吻合手術的成人患者. 干預:結直腸吻合手術的吻合器與手縫法. 結果： a)死亡率b)整體吻合滲漏c)臨床吻合滲漏d)放射學吻合滲漏e)狹窄f)吻合出血g)再手術h)傷口感染i)吻合時間j)住院

資料收集與分析

由兩個審評獨立提取數據和交叉檢查(SASL, DM)，每次試驗由相同的兩個審評以質量法進行評估.隨機化的細節完成意向性治療分析.當中有多少病人失去了後續的記錄.結果每一個隨機對照試驗的總結在一個意向性治療的基礎上，每項成果在2 �2表上.外部效度定義為特徵的參與者，干預措施和成果.隨機對照試驗按照大腸癌的水平吻合分層,差分方法的風險(隨機效應模型)和NNT的兩分法成果的措施和加權均數差持續成果的措施，相應的95％置信區間提交了審查,統計異質性進行了評估採用漏斗圖和chisquare testing.

主要結論

在登記的1233例(9試驗)，622例釘子法611例手縫法.以下主要研究結果發現： a)死亡率:根據901例結果;風險差異 −0.6％ −2.8％置信區間為1.6％ b) 整體裂開:結果根據1233例;風險差0.2％，95％置信區間 −5.0％至+5.3％ c)臨床吻合口裂開:結果根據1233例;風險差 −1.4％，95％置信區間 −5.2至+2.3％ d)放射吻合口裂開:結果根據825例;風險差1.2％，95％置信區間4.8％至7.3％ e)狹窄：結果根據1042例;風險差4.6％，95％置信區間1.2％至8.1％. 需要治療數17，95％可信區間12至31. f)吻合口出血： 結果根據662例;風險差2.7％，95％置信區間 −0.1％至5.5％. g)再手術：結果544名病人的基礎上，風險差3.9％，95％置信區間0.3％至7.4％. h)傷口感染：結果根據567例;風險差1.0％，95％置信區間 −2.2％至+4.3％. i)吻合時間：結果根據一項研究(159例);加權均數差 −7.6分鐘，95％置信區間 −12.9至 −2.2分鐘. j)住院：結果根據一項研究(159例)，加權平均差二點?天，95％置信區間 −3.27至七點二天.

作者結論

不論吻合的水平,發現的證據不足以證明結直腸吻合手術的吻合器法優越於手縫法

翻譯人

本摘要由國泰綜合醫院張世昌翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

發現的證據不足以證明結直腸吻合手術的吻合器法優越於手縫法,在獨立的吻合水平.在審查9隨機對照試驗(1233例，622例吻合器法和611例手縫法)目前已進行了比較，結直腸吻合手術吻合器法與手縫法的安全性和有效性.分析執行使用95％風險差異和加權平均相差，相應的置信區間。 結果計量死亡率，吻合口裂開，狹窄，出血，再手術，傷口感染，吻合時間(執行吻合所需時間)和住院。除了吻合器法較易狹窄(p<0,05),手縫法所花費的時間較長,統計發現無顯著性差異.

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