title: Hand-sewn versus stapled oesophago-gastric anastomosis: systematic review and meta-analysis.
abstract: OBJECTIVE
  In this meta-analysis, data from relevant randomised controlled trials has been pooled together to gain a consensus in the comparison of outcome following hand-sewn versus stapled oesophago-gastric (OG) anastomoses.
  
  
  METHODS
  Medline, Embase, Cochrane, trial registries, conference proceedings and reference lists were searched for randomised controlled trials comparing hand-sewn and stapled OG anastomoses. Primary outcome measures were 30-day mortality, anastomotic leakage and stricture. Secondary outcomes were operative time, cardiac complications and pulmonary complications.
  
  
  RESULTS
  Nine randomised trials were included in this meta-analysis. There was no significant difference between the groups for 30-day mortality (pooled odds ratio = 1.71; 95% CI = 0.822 to 3.56; P = 0.15) and anastomotic leakage (pooled odds ratio = 1.06; 95% CI = 0.62 to 1.80; P = 0.83). There was a significantly increased rate of anastomotic stricture associated with stapled OG anastomosis (pooled odds ratio = 1.76; 95% CI = 1.09 to 2.86; P = 0.02).
  
  
  CONCLUSIONS
  Meta-analysis of randomised controlled trials comparing hand-sewn with stapled OG anastomosis demonstrates that a stapled anastomosis is associated with a shorter operative time but with an increased rate of post-operative anastomotic stricture.
authors.affiliation: Department of General Surgery, University College London Hospital, 235 Euston Road, London, UK. sheraz_markar@hotmail.com
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: Soumil
authors.initials: S
authors.lastname: Vyas
authors.forename: Majid
authors.initials: M
authors.lastname: Hashemi
authors.forename: Mark
authors.initials: M
authors.lastname: Winslet
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control; D004935:Esophageal Diseases / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D013270:Stomach / Q000601:surgery*; D017792:Surgical Stapling / Q000295:instrumentation*; D016896:Treatment Outcome