title: Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: systematic review and meta-analysis.
abstract: BACKGROUND
  Postoperative anastomotic leak and stricture are dramatic events that cause increased morbidity and mortality, for this reason it's important to evaluate which is the best way to perform the anastomosis.
  
  
  OBJECTIVE
  To compare the techniques of manual (hand-sewn) and mechanic (stapler) esophagogastric anastomosis after resection of malignant neoplasm of esophagus, as the occurrence of anastomotic leak, anastomotic stricture, blood loss, cardiac and pulmonary complications, mortality and surgical time.
  
  
  METHODS
  A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) using the combination of descriptors (anastomosis, surgical) and (esophagectomy) was performed.
  
  
  RESULTS
  Thirteen randomized trials were included, totaling 1778 patients, 889 in the hand-sewn group and 889 in the stapler group. The stapler reduced bleeding (p <0.03) and operating time (p<0.00001) when compared to hand-sewn after esophageal resection. However, stapler increased the risk of anastomotic stricture (NNH=33), pulmonary complications (NNH=12) and mortality (NNH=33). There was no significant difference in relation to anastomotic leak (p=0.76) and cardiac complications (p=0.96).
  
  
  CONCLUSIONS
  After resection of esophageal cancer, the use of stapler shown to reduce blood loss and surgical time, but increased the incidence of anastomotic stricture, pulmonary complications and mortality.
authors.affiliation: Lusiada University Center, Santos, SP, Brazil.
authors.forename: Paula Marcela Vilela
authors.initials: PM
authors.lastname: Castro
authors.affiliation: Lusiada University Center, Santos, SP, Brazil.
authors.forename: Felipe Piccarone Gonçalves
authors.initials: FP
authors.lastname: Ribeiro
authors.affiliation: Lusiada University Center, Santos, SP, Brazil.
authors.forename: Amanda de Freitas
authors.initials: Ade F
authors.lastname: Rocha
authors.affiliation: Lusiada University Center, Santos, SP, Brazil.
authors.forename: Mônica
authors.initials: M
authors.lastname: Mazzurana
authors.affiliation: Lusiada University Center, Santos, SP, Brazil.
authors.forename: Guines Antunes
authors.initials: GA
authors.lastname: Alvarez
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D013270:Stomach / Q000601:surgery*; D017792:Surgical Stapling; D013536:Suture Techniques