This is not the most recent version of the article. View current version (7 SEP 2011)
Stapled versus handsewn methods for ileocolic anastomoses
Editorial Group: Cochrane Colorectal Cancer Group
Published Online: 18 JUL 2007
Assessed as up-to-date: 28 FEB 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Choy PYG, Bissett IP, Docherty JG, Parry BR, Merrie A. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004320. DOI: 10.1002/14651858.CD004320.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 JUL 2007
This is not the most recent version of the article. View current version (07 SEP 2011)
Ileocolic anastomoses are commonly performed for right-sided colon cancer and Crohn's disease. The anastomosis may be constructed using a linear cutter stapler or by suturing. 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. To our knowledge, this is the first systematic review specifically investigating ileocolic anastomosis.
To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. The hypothesis tested was that the stapling technique is associated with fewer complications.
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. Abstracts presented to the following society meetings between 1970 and 2002 were handsearched: American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, European Association of Coloproctology.
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.
Data collection and analysis
Eligible studies were selected and their methodological quality assessed. Relevant results were extracted and missing data sought from the authors. RevMan 4.2 Analysis version 1.0.5 was used to perform meta-analysis when there were sufficient data. Sub-group analyses for cancer and inflammatory bowel disease as indication for ileocolic anastomoses were performed.
After obtaining individual data from authors for studies that include other anastomoses, six trials (including one unpublished) with 955 ileocolic participants (357 stapled, 598 handsewn) were included. The three largest trials had adequate allocation concealment. Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with handsewn (S=5/357, HS=36/598, OR 0.34 [0.14, 0.82] p=0.02). One study performed routine radiology to detect asymptomatic leaks. For the sub-group of 825 cancer patients in four studies, stapled anastomosis led to significant fewer anastomotic leaks (S=4/300, HS=35/525, OR 0.28 [0.10, 0.75] p=0.01). There were too few Crohn's disease patients to perform sub-group analysis. All other outcomes: stricture, anastomotic haemorrhage, anastomotic time, re-operation, mortality, intra-abdominal abscess, wound infection, length of stay, showed no significant difference.
Stapled functional end to end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis.
Plain language summary
Stapled ileocolic anastomosis has a lower anastomotic leak rate compared with the handsewn technique, particularly in surgery performed for bowel cancer.
After surgery for right-sided bowel cancer or Crohn's disease, the bowel ends may be joined either by the use of a stapler or by manual suturing. This systematic review found 6 randomised controlled trials with a total of 955 participants (357 stapled, 598 handsewn) comparing these two methods. Anastomotic leak rate for stapled anastomosis was 1.4%, significantly lower than handsewn (6%) p=0.02. For the sub-group of 825 cancer patients in four studies, the result was similar. There was no significant difference in the other outcomes of stricture, anastomotic haemorrhage, anastomotic time, re-operation, mortality, intra-abdominal abscess, wound infection and length of stay, although these were not consistently reported.