Esophagojejunostomy after total gastrectomy: A systematic review and meta‐analysis comparing hand‐sewn and stapled anastomosis

Abstract

This review aims to evaluate the surgical outcomes of hand‐sewn esophageal anastomosis compared to mechanical anastomosis to reconstruct total gastrectomy. A systematic review and meta‐analysis of comparative studies evaluating hand‐sewn and stapled anastomosis were performed. A total of 12 studies were selected, comprising 1761 individuals. The results indicate that the hand‐sewn and stapled esophageal anastomosis have similar surgical outcomes. Stapled anastomosis has a shorter operation time.

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

“…Overall complications rate in our study was 18.1%, with no significant difference between the analyzed groups (21% for hand-sewn; 16% for stapler group; P=0.50), same as reported in a recent meta-analysis [6]. The work of Watanabe, et al from Japan on over 20 000 patients reported overall morbidity at 26.2%, which is similar to our study [37].…”

“…There was no significant difference in hospital mortality between the hand-sewn and stapled anastomosis groups in our study (P=0.837). A meta-analysis on esophagogastric anastomosis by Markar et al, as well as recent meta-analysis on esophago-jejunal anastomosis, confirmed these results [6,50]. Two large-cohort studies performed using the National Cancer Databases reported in-hospital mortality (2.2%), 30-day mortality (0.9-4.7%), and 90-day mortality (9.1%) [37,51].…”

“…However, there are conflicting reports on this issue. A recent meta-analysis [ 6 ] revealed that duration of the surgery was 22 minutes shorter for stapling anastomosis than for hand-sewn EJA, but without further impact on the morbidity and mortality after surgery. However, the analysis included data from studies comparing different surgical techniques linear and circular stapling and laparoscopic and open gastrectomy.…”

“…EJA may be performed using traditional hand-sewn technique or mechanical stapling, using linear or circular devices [1]. Although stapled anastomosis is a well-described and commonly used method, there is little recent data regarding the surgical complications of open total gastrectomy with comparison of stapled and hand-sewn esophago-jejunal anastomosis [6]. Some previous studies found a reduction in duration of the surgery, along with lower incidence of anastomotic leakage and higher rate of strictures in the stapler group, while others reported no difference between these 2 techniques [7][8][9][10].…”

“…Some previous studies found a reduction in duration of the surgery, along with lower incidence of anastomotic leakage and higher rate of strictures in the stapler group, while others reported no difference between these 2 techniques [7][8][9][10]. A recent meta-analysis showed that hand-sewn and stapled anastomosis have similar surgical outcomes, while staplers reduce the operative time [6], but the recent data about open TG are limited. Only 12 studies were included in the meta-analysis, with 1 recent study on open TG comprising 63 patients [11].…”