Highlights
- •The best anastomotic technique after laparoscopic total gastrectomy is not clear.
- •This systematic review with meta-analysis try to clarify whether side-to-side oesophagojejunal anastomosis is better than end-to-end.
- •Studies showed a significant difference in terms of “overall anastomotic complications” in favour of linear stapling.
- •Linear stapler seems to be related with lesser number of complication if compared with circular stapler.
Abstract
Background
To assess which anastomosis technique is the most appropriate after laparoscopic total
gastrectomy, a systematic review with meta-analysis has been performed to evaluate
safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy.
Methods
A systematic search was performed using the string: total AND gastrectomy AND (circular
OR linear OR stapler). Extracted data were patients’ number, gender, age, BMI, ASA
Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall
anastomotic complications, mortality, operative time, time to first flatus and diet
resumption and length of stay of each group. A meta-analysis among the included studies
was performed. A subgroup analysis, including the studies in which the Authors considered
a single technique to perform each type of anastomosis (LS and CS), was performed.
Meta-regression analyses were performed to assess if one or more demographic and clinical
variables significantly impacted on the obtained results.
Results
12 articles were included in the final analysis. A significant difference was observed
in terms of “overall anastomotic complications” in favour of linear stapling (RD = 0.06,
p = 0.01). No significant differences were observed in terms of postoperative complications
anastomosis-related, even if a trend towards advantages of linear stapling have been
found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all
the study was retrospective and there was high heterogeneity among the studies.
Conclusion
Linear stapler seems to be related with lesser number of complication if compared
with circular stapler. However, further high-quality studies are needed to obtain
definitive conclusions.
Keywords
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Article info
Publication history
Published online: October 01, 2021
Accepted:
September 23,
2021
Received in revised form:
July 24,
2021
Received:
February 27,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
