![]() Stapled functional end to end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis. All other outcomes: stricture, anastomotic haemorrhage, anastomotic time, re-operation, mortality, intra-abdominal abscess, wound infection, length of stay, showed no significant difference. In subgroup analysis of non-cancer patients (3 studies, 264 patients) there were no differences for any reported outcomes. ![]() For the sub-group of 825 cancer patients in four studies, stapled anastomosis led to significantly fewer anastomotic leaks (S=4/300, HS=35/525, OR 0.28 p=0.01). One study performed routine radiology to detect asymptomatic leaks. The five largest trials had adequate allocation concealment.Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with handsewn (S=11/441, HS=42/684, OR 0.48 p=0.03). Sub-group analyses for cancer inflammatory bowel disease as indication for ileocolic anastomoses were performed.Īfter obtaining individual data from authors for studies that include other anastomoses, seven trials (including one unpublished) with 1125 ileocolic participants (441 stapled, 684 handsewn) were included. RevMan 5 was used to perform meta-analysis when there were sufficient data. Relevant results were extracted and missing data sought from the authors. When a part of the small or large intestine is surgically removed due to a disease or condition, the two sections of the remaining part of the intestine are joined together (intestinal anastomosis) to re-establish the continuity of the intestine. Randomised controlled trials comparing use of linear cutter stapler (isoperistaltic side to side or functional end to end) with any type of suturing technique in adults.Įligible studies were selected and their methodological quality assessed. An anastomosis is a medical term used to describe connection or opening between two organs or tissues. Abstracts presented to the following society meetings between 19 were handsearched: American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, European Association of Coloproctology. MEDLINE, EMBASE, Cochrane Colorectal Cancer Group specialised register SR-COLOCA, Cochrane Library were searched for randomised controlled trials comparing use of a linear cuter stapler with any type of suturing technique for ileocolic anastomoses in adults from 1970 to 2005 and were updated in December 2010. The hypothesis tested was that the stapling technique is associated with fewer complications. To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. This is an update of a Cochrane review first published in 2007. Individual trials comparing stapled versus handsewn ileocolic anastomoses have found little difference in the complication rate but they have lacked adequate power to detect potential small difference. The anastomosis may be constructed using a linear cutter stapler or by suturing. After discharging the stapling instrument, the excess tissue is cut from above the instrument jaws while preserving the traction sutures on either end ( figure 6).Ileocolic anastomoses are commonly performed for right-sided colon cancer and Crohn's disease. This ensures inclusion of all bowel wall in the deep staple line. The noncutting linear stapler (TL 60) is positioned transversely below the Allises and traction sutures ( figure 5). The full thickness of bowel wall along the mesenteric border is aligned with several through-and-through traction sutures or a row of Allis clamps ( figure 4). Anterior and posterior traction sutures (A and B) are placed halfway between the mesenteric and antimesenteric borders. The mesenteric opening is closed with interrupted fine silk sutures ( figure 3). The two limbs of open bowel are brought in approximation with correct mesentery-to-mesentery alignment ( figure 2). Obvious bleeding points are controlled with fine ligatures. The field is walled off with laparotomy pads and the clamps are opened. ![]() The specimen is excised between the Kocher and straight clamps. We hypothesized that the brand of stapler was the most significant factor in the rate of leaks. A string of recent anastomotic leaks prompted analysis of risk factors. The vast majority of colonic anastomoses are created using mechanical staplers. Several inches beyond these, noncrushing Scudder or rubber-shod clamps are applied to prevent gross contamination. Anastomotic leaks are one of the most feared complications of intestinal surgery. The section of the bowel to be excised is isolated with Kocher clamps while thin straight clamps, such as Glassman clamps, are placed transversely on the colon ( figure 1).
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