title: Is "functional end-to-end anastomosis" really functional? A review of the literature on stapled anastomosis using linear staplers.
abstract: OBJECTIVE
  Anastomosis is one of the basic skills of a gastrointestinal surgeon. Stapling devices are widely used because stapled anastomosis (SA) can shorten operation times. Antiperistaltic stapled side-to-side anastomosis (SSSA) using linear staplers is a popular SA technique that is often referred to as "functional end-to-end anastomosis (FEEA)." The term "FEEA" has spread without any definite validation of its "function." The aim of this review is to show the heterogeneity of SA and conventional hand-sewn end-to-end anastomosis (HEEA) and to advocate the renaming of "FEEA."
  
  
  METHODS
  We conducted a narrative review of the literature on SSSA. We reviewed the literature on ileocolic and small intestinal anastomosis in colonic cancer, Crohn's disease and ileostomy closure due to the simplicity of the technique.
  
  
  RESULTS
  The superiority of SSSA in comparison to HEEA has been demonstrated in previous clinical studies concerning gastrointestinal anastomosis. Additionally, experimental studies have shown the differences between the two anastomotic techniques on peristalsis and the intestinal bacteria at the anastomotic site.
  
  
  CONCLUSIONS
  SSSA and HEEA affect the postoperative clinical outcome, electrophysiological peristalsis, and bacteriology in different manners; no current studies have shown the functional equality of SSSA and HEEA. However, the use of the terms "functional end-to-end anastomosis" and/or "FEEA" could cause confusion for surgeons and researchers and should therefore be avoided.
authors.affiliation: Department of Frontier Surgery, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-0856, Japan. mkano@chiba-u.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kano
authors.affiliation: Department of Frontier Surgery, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-0856, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hanari
authors.affiliation: Department of Frontier Surgery, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-0856, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Gunji
authors.affiliation: Department of Frontier Surgery, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-0856, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hayano
authors.affiliation: Department of Frontier Surgery, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-0856, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Department of Frontier Surgery, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, 260-0856, Japan.
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007081:Ileostomy / Q000295:instrumentation / Q000379:methods; D007422:Intestines / Q000382:microbiology; D061646:Operative Time; D010528:Peristalsis; D013528:Surgical Staplers; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
keywords: Functional end-to-end anastomosis; Linear stapler; Stapled anastomosis