Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

Abstract

Purpose Anastomosis creation after resective gastrointestinal surgery is a crucial task. The present review examines the techniques and implants currently available for anastomosis creation and analyses to which extent they already address our clinical needs, with a special focus on their potential to enable further trauma minimization in visceral surgery. Methods A multi-database research was conducted in MEDLINE, Scopus, and Cochrane Library. Comparative controlled and uncontrolled clinical trials dealing with anastomosis creation techniques in the intestinal tract in both German and English were included and statistically significant differences in postoperative complication incidences were assessed using the RevMan5.4 Review Manager (Cochrane Collaboration, Oxford, UK). Results All methods and implant types were analyzed and compared with respect to four dimensions, assessing the techniques’ current performances and further potentials for surgical trauma reduction. Postoperative outcome measures, such as leakage, stenosis, reoperation and mortality rates, as well as the tendency to cause bleeding, wound infections, abscesses, anastomotic hemorrhages, pulmonary embolisms, and fistulas were assessed, revealing the only statistically significant superiority of hand-suture over stapling anastomoses with respect to the occurrence of obstructions. Conclusion Based on the overall complication rates, it is concluded that none of the anastomosis systems addresses the demands of operative trauma minimization sufficiently yet. Major problems are furthermore either low standardization potentials due to dependence on the surgeons’ levels of experience, high force application requirements for the actual anastomosis creation, or large and rigid device designs interfering with flexibility demands and size restrictions of the body’s natural access routes. There is still a need for innovative technologies, especially with regard to enabling incisionless interventions.

Desenvolvimentos Recentes em Técnicas de Anastomose para Cirurgia Gastrointestinal: Uma Revisão

“…Além disso, a comparação direta entre diferentes técnicas de anastomose muitas vezes é complicada pela falta de padronização nos critérios de avaliação e nos desfechos medidos. Isto sublinha a necessidade de ensaios clínicos randomizados e estudos prospectivos bem desenhados, que possam fornecer evidências robustas sobre a eficácia relativa e a segurança das várias técnicas de anastomose (Steger et al, 2022;Parmar & Mahawar, 2018).…”

“…A anastomose, o processo de conectar dois segmentos do trato gastrointestinal, é um componente fundamental das cirurgias GI, influenciando diretamente os resultados pós-operatórios, como a recuperação do paciente, a taxa de complicações e a funcionalidade a longo prazo do sistema GI. O interesse contínuo em aprimorar essas técnicas reflete a busca pela redução de complicações pósoperatórias, como vazamentos anastomóticos e estenose, que podem ter impactos significativos na qualidade de vida dos pacientes (Marrache et al, 2020;Steger et al, 2022).…”

The comparison of anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis

“…The full-thickness anastomosis technique increased the damage of mucosal and submucosal vascular plexus through suture. Differ with the extramucosal anastomosis technique, which only connected the intestine’s strongest layer (muscularis in submucosa), preserving the submucosal vascular plexus, thus reduce the risk of bowel ischemia 7 , 11 . Other theory about leaving the mucosa free was that the mucosa heals quickly and a water shield forms within 24 h 1 .…”

Endoscopic management of postoperative bleeding

“…35 Regarding suture technique, there was no statistically significant difference in the rate of bleeding between hand-suture and stapling techniques in a recent meta-analysis of 26 studies. 36…”