Meta-analysis of hand-sewn versus mechanical gastrojejunal anastomosis during laparoscopic Roux-en-Y gastric bypass for morbid obesity.
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most performed bariatric procedures in treating morbid obesity. There is no consensus on which technique used for gastrojejunal anastomosis is optimal. The meta-analysis aimed to solve the issue by comparing hand-sewn with mechanical gastrojejunostomy during LRYGB for morbid obesity.


METHODS
PubMed, Embase, Cochrane Library, Scopus, Google Scholar and Research Gate were searched (from inception to April 2016). Primary outcome was operation time. Secondary outcomes were postoperative complications (anastomotic leak, stricture, bleeding, marginal ulcer and wound infection), percent excess weight loss during one-year follow-up, reoperation, and postoperative hospital stay. Odds ratios (OR) were calculated for dichotomous outcomes and mean differences (MD) for continuous outcomes.


RESULTS
Twelve trials were included comprising 13,626 patients (3309 hand-sewn vs. 6791 circular vs. 3526 linear). There was no difference in operation time when hand-sewn anastomosis was compared with mechanical gastrojejunostomy (MD, -6.00; 95% confidence interval (CI), -34.85 to 22.85; P = 0.68), circular stapled anastomosis (MD, -5.24; 95% CI, -32.71 to 22.24; P = 0.71) or linear stapled anastomosis (MD, - 3.75; 95% CI, -64.81 to 57.31; P = 0.90). Hand-sewn anastomosis had significantly lower incidence rate of postoperative bleeding (OR, 0.48; 95% CI, 0.31-0.74; P = 0.001) and wound infection (OR, 0.19; 95% CI, 0.08-0.45; P = 0.0002) than circular stapled anastomosis; there were no significant differences in the other secondary outcome. And there were no significant differences in all the comparable outcomes between hand-sewn anastomosis and linear stapled anastomosis.


CONCLUSIONS
This meta-analysis revealed no significant differences between mechanical and hand-sewn anastomosis except for greater incidence rates of postoperative bleeding and wound infection with the use of circular staplers. Besides, more trials with adequate power are required and a cost analysis also worth trying. REGISTRATION NO.
CRD42015020025.
Department of General Surgery, The First Clinical Hospital, Harbin Medical University, Harbin 150001, China.
Hong-Peng
HP
Jiang
Department of General Surgery, The First Clinical Hospital, Harbin Medical University, Harbin 150001, China.
Le-Le
LL
Lin
Department of General Surgery, The First Clinical Hospital, Harbin Medical University, Harbin 150001, China.
Xian
X
Jiang
Department of General Surgery, The First Clinical Hospital, Harbin Medical University, Harbin 150001, China. Electronic address: qiaohaiquan@hotmail.com.
Hai-Quan
HQ
Qiao
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000009:adverse effects; D013528:Surgical Staplers / Q000009:adverse effects*; D013536:Suture Techniques / Q000009:adverse effects* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D015431:Weight Loss
Anastomosis; Hand sewing; Laparoscopic Roux-en-Y gastric bypass; Morbid obesity; Stapler