Is hand-sewn anastomosis superior to stapled anastomosis following oesophagectomy?
A best evidence topic was written according to a structured protocol. The question addressed was: In patients undergoing oesophagectomy is stapled anastomosis (STA) superior to hand-sewn anastomosis (HSA) with respect to post-operative outcomes. In total, 82 papers were found suitable using the reported search and 14 of these represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing evidence shows that STA is associated with reduced time to anastomotic construction and decreased intra-operative blood loss but increased risk of benign stricture formation compared to HSA. There is no difference between HSA and STA with respect to cardiac or respiratory complications, anastomotic leakage, duration of hospital admission or 30-day mortality. In HSA, increasing surgical experience and intra-operative air leakage testing after anastomotic creation are associated with reduced risk of anastomotic leakage. Further adequately powered studies will enable identification of other local and systemic factors influencing anastomotic healing, which will lead to improved patient and anastomotic technique selection for optimal surgical outcomes.
Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK. Electronic address: babar.kayani@gmail.com.
Babar
B
Kayani
Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
George
G
Garas
Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
Mubarik
M
Arshad
Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
Thanos
T
Athanasiou
Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
Ara
A
Darzi
Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK. Electronic address: manoszacharakis@hotmail.com.
Emmanouil
E
Zacharakis
D000714:Anastomosis, Surgical / Q000379:methods*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome
Anastomosis; Hand-sewn; Manual; Mechanical; Oesophagus; Outcomes; Stapled