4.2 Article

Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis

期刊

JOURNAL OF INVESTIGATIVE SURGERY
卷 35, 期 7, 页码 1434-1444

出版社

TAYLOR & FRANCIS INC
DOI: 10.1080/08941939.2022.2058126

关键词

linear stapler; circular stapler; anastomosis; laparoscopic gastrectomy; reconstruction

类别

资金

  1. National Natural Science Foundation of China [81772547]
  2. Fundamental Research Funds for the Central Universities [2017SCU04A18]
  3. Young Scientific and Academic Leaders Training Program of Sichuan University [0082604151001/035]
  4. Foundation of Science & Technology Department of Sichuan Province [2019YFS0256]
  5. 1. 3. 5 Project for Disciplines of Excellence, West China Hospital, Sichuan University [ZY2017304]

向作者/读者索取更多资源

A meta-analysis comparing linear stapling and circular stapling for anastomosis after laparoscopic gastric surgery found that linear stapling resulted in lower incidence of overall morbidity, anastomotic complications, anastomotic stricture, bleeding, and wound infection, indicating that it is a safer and more efficient technique.
Background Anastomotic devices, including linear staplers (LSs) and circular staplers (CSs), have been widely used after laparoscopic gastric surgery. However, it is controversial whether linear stapling is superior to circular stapling for anastomosis. Thus, we conducted a meta-analysis to compare the aspects of postoperative complications, particularly anastomotic stricture and anastomotic leakage, on the use of the two techniques to assist clinical decision-making. Methods We conducted a systematic search using Embase, PubMed, and Cochrane Library to evaluate studies that compared LSs and CSs after laparoscopic gastric surgery. Results Pooled analysis suggested that patients who received LSs had fewer postoperative complications (P = 0.019), and anastomotic complications (P < 0.001), stricture (P = 0.001), and bleeding (P = 0.005). The subgroup analyses showed that LSs caused fewer anastomotic complications (P < 0.001), anastomotic strictures (P < 0.001), and postoperative hemorrhage (P = 0.007) in patients with gastric cancer than CS. In addition, LSs caused fewer incidences of overall morbidity (P = 0.042), anastomotic strictures (P = 0.023), postoperative hemorrhage (P < 0.001), wound infection (P < 0.001), and shorter length of hospital stay (P = 0.048) in patients with obesity. Furthermore, the subgroup analyses showed that the use of LS resulted in lower overall morbidity (P = 0.042), anastomotic stricture (P = 0.023), wound infection (P < 0.001), length of hospital stay (P = 0.048), and postoperative hemorrhage (P < 0.001) when applied in gastrojejunostomy, while LSs resulted in fewer anastomotic complications (P < 0.001), anastomotic stricture (P = 0.016) than CS when applied in esophagojejunostomy. Conclusion Compared with CSs, LSs yielded a lower incidence of overall morbidity, anastomotic complications, anastomotic stricture, bleeding, and wound infection, indicating that linear stapling is safer and more efficient than circular stapling when performing anastomosis after laparoscopic gastric surgery.

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