META ANALYSIS OF THE INCIDENCE OF LEAKAGE AND STRICTURE FORMATION AFTER HAND-SEWN VERSUS STAPLED ESOPHAGO-GASTRIC ANASTOMOSIS

Ali, Nader Megahed; Al Akaad, Hesham Abdel Raouf; Mahfouz, Mohammed; ELhefny, Amr Mohamed M.; Saad, Ahmed Saeed

doi:10.21608/asmj.2022.252415

META ANALYSIS OF THE INCIDENCE OF LEAKAGE AND STRICTURE FORMATION AFTER HAND-SEWN VERSUS STAPLED ESOPHAGO-GASTRIC ANASTOMOSIS

Document Type : Original Article

Authors

¹ General surgeon specialist El-Hammam General Hospital – Marsa Matrouh . Egypt.

² Department of General Surgery and Upper GIT Surgery, Faculty of Medicine, Ain-Shams University . Cairo, Egypt.

10.21608/asmj.2022.252415

Abstract

Background: Esophagectomy is a major operation indicated for many reasons mainly in esophageal cancer and loss of esophageal function, this operation due to many considerations we can say it is a true challenge to the upper GI surgeon.
Aim of the work: The main purpose of the present study is to review the difference between hand-sewn and stapler esophagogastric anastomosis as regards post-operative leakage and stricture formation.
Patients and Methods: In the present study, we searched Medline via Pub Med, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. In the present systematic review and meta-analysis, A 746 cases were included in hand sewn group and 691 cases in stapled anastomosis.
Results: In the present systematic review and meta-analysis, 9 studies including a total of 1437 patients reported the leak incidence. There was a statistically insignificant heterogeneity in the studies. Using the random effects model, the outcome results revealed that hand sewn was significantly more than stapled anastomosis regarding leak incidence. In the present systematic review and meta-analysis, 9 studies including a total of 1437 patients (746 in hand sewn and 691 stapled anastomosis)—reported the Stricture incidence. There was a statistically insignificant heterogeneity in the studies. Using the random effects model, the outcome results revealed that hand sewn was significantly less than stapled anastomosis regarding stricture incidence.
Conclusion: This meta-analysis, comparing stapled and hand sewn esophagogastric anastomosis, showed that stapled anastomosis decreased the rate of anastomotic leak, increased the rate of anastomotic stricture, shortened the operating time, decreased the rate of post-operative complications but the cost of using staplers is high compared to the hand sewn technique.

Keywords

Main Subjects