Stapled side-to-side anastomosis might be better than handsewn end-to-end anastomosis in ileocolic resection for Crohn's disease: a meta-analysis.
BACKGROUND
Ileocolic anastomosis is an essential step in the treatment to restore continuity of the gastrointestinal tract following ileocolic resection in patients with Crohn's disease (CD). However, the association between anastomotic type and surgical outcome is controversial.


OBJECTIVE
The aim of this meta-analysis is to compare surgical outcomes between stapled side-to-side anastomosis (SSSA) and handsewn end-to-end anastomosis (HEEA) after ileocolic resection in patients with CD.


METHODS
Studies comparing SSSA with HEEA after ileocolic resection in patients with CD were identified in PubMed and EMBASE. Outcomes such as complication, recurrence, and re-operation were evaluated. Eight studies (three randomized controlled trials, one prospective non-randomized trial, and four non-randomized retrospective trials) comparing SSSA (396 cases) and HEEA (425 cases) were included.


RESULTS
As compared with HEEA, SSSA was superior in terms of overall postoperative complications [odds ratio (OR), 0.54; 95 % confidence interval (CI) 0.32-0.93], anastomotic leak (OR 0.45; 95 % CI 0.20-1.00), recurrence (OR 0.20; 95 % CI 0.07-0.55), and re-operation for recurrence (OR 0.18; 95 % CI 0.07-0.45). Postoperative hospital stay, mortality, and complications other than anastomotic leak were comparable.


CONCLUSIONS
Based on the results of our meta-analysis, SSSA would appear to be the preferred procedure after ileocolic resection for CD, with reduced overall postoperative complications, especially anastomotic leak, and a decreased recurrence and re-operation rate.
Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, Guangdong, People's Republic of China.
Xiaosheng
X
He
Zexian
Z
Chen
Juanni
J
Huang
Lei
L
Lian
Santosh
S
Rouniyar
Xiaojian
X
Wu
Ping
P
Lan
D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007902:Length of Stay; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome