title: Hand suture versus stapler for closure of loop ileostomy--a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The aims of this study are to compare the 30-day rate of bowel obstruction for stapled vs. handsewn closure of loop ileostomy, and to further assess efficacy and safety for each technique by secondary endpoints such as operative time, rates of anastomotic leakage, and other post-operative complications within 30 days.
  
  
  METHODS
  A systematic literature search (MEDLINE, The Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomized controlled trials (RCTs) comparing stapled and handsewn closure of loop ileostomy after low anterior resection. Random effects meta-analyses were calculated and presented as risk ratio (RR) and mean difference (MD) with corresponding 95 % confidence intervals.
  
  
  RESULTS
  Forty publications were retrieved and 4 RCTs (649 patients) were included. There was methodological and clinical heterogeneity of included trials, but statistical heterogeneity was low for most endpoints. Stapler use significantly reduced the rate of bowel obstruction compared to hand-sewn closure (RR 0.53 [0.32, 0.88]; P = 0.01). The operation time was significantly lower for stapling compared to hand suture (MD -15.5 min [-18.4, 12.6]; P < 0.001). All other secondary outcomes did not show significant differences.
  
  
  CONCLUSIONS
  This meta-analysis shows superiority of stapled closure of loop ileostomy compared to handsewn closure in terms of bowel obstruction rate and mean operation time. Other relevant complications such as anastomotic leakage are equivalent. Even so, both techniques are options with opposing advantages and disadvantages.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Löffler
authors.forename: Inga
authors.initials: I
authors.lastname: Rossion
authors.forename: Käthe
authors.initials: K
authors.lastname: Gooßen
authors.forename: Daniel
authors.initials: D
authors.lastname: Saure
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Markus K
authors.initials: MK
authors.lastname: Diener
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods*; D007415:Intestinal Obstruction / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D017792:Surgical Stapling / Q000379:methods*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome