title: Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the risks and benefits of using a circular stapler (CS) compared with the hand-sewn (HS) method for the esophagogastric anastomosis after esophageal resection.
  
  
  BACKGROUND
  Previous randomized controlled trials (RCTs) indicated that the use of a CS might prevent anastomotic leakage, whereas it was more likely to lead to anastomotic strictures. The relative efficacy of this intervention in comparison with the HS method has not been conclusively determined.
  
  
  METHODS
  A systematic review and meta-analysis of all RCTs that compared HS versus mechanical anastomosis using a CS was conducted regarding the leakage, strictures, operative time, and mortality. The study protocol was established a priori according to the recommendations of the Cochrane Collaboration.
  
  
  RESULTS
  Twelve RCTs were included with a total of 1407 patients. The use of a CS, compared with the HS method, (1) led to no significant difference in the incidence of anastomotic leakage [risk ratio (RR): 1.02, 95% confidence interval (CI): 0.66-1.59] or postoperative mortality (RR: 1.64, 95% CI: 0.95-2.83), (2) increased the incidence of anastomotic strictures (RR: 1.67, 95% CI: 1.16-2.42), and (3) reduced the length of the operation time (mean: -15.3 minutes, range: -28.1 to -2.39). For these results, a subgroup analysis and a meta-regression analysis yielded no significant differences for the anastomotic site, diameter of the CS, layer, or configuration.
  
  
  CONCLUSIONS
  The use of a CS contributed to reducing the length of the operation, but was associated with an increased risk of anastomotic strictures. Both the CS and the HS method are viable alternatives in the reconstruction after esophagectomy.
authors.affiliation: Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan. mhonda@frontier.kyoto-u.ac.jp
authors.forename: Michitaka
authors.initials: M
authors.lastname: Honda
authors.forename: Akira
authors.initials: A
authors.lastname: Kuriyama
authors.forename: Hisashi
authors.initials: H
authors.lastname: Noma
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Toshi A
authors.initials: TA
authors.lastname: Furukawa
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D004867:Equipment Design; D016629:Esophagectomy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013528:Surgical Staplers; D013536:Suture Techniques