Penna Marta, Markar Sheraz R, Venkat-Raman Vishal, Karthikesalingam Alan, Hashemi Majid
UCLH Department of Weight Loss, Metabolic and Endocrine Surgery, University College London Hospital, London, UK.
Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):95-101. doi: 10.1097/SLE.0b013e3182470f38.
The study aims to provide a pooled analysis of individual small trials comparing linear-stapled versus circular-stapled laparoscopic gastrojejunal (GJ) anastomosis in morbid obesity surgery.
A systematic literature search of Medline, Embase, and Cochrane library databases was performed. Primary outcomes were GJ leak and stricture. Secondary outcomes were operative time, length of hospital stay, postoperative bleeding, wound infection, marginal ulcers, and estimated weight loss. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes.
Nine trials were included comprising 9374 patients (2946 linear vs. 6428 circular). Primary outcome analysis revealed a statistically significant increase in the rate of GJ stricture associated with circular-stapled anastomosis. A significantly reduced rate of wound infection, bleeding, and operative time associated with linear stapling was also found. No significant differences appeared for the other outcomes.
This pooled analysis recommends the preferential use of the linear stapling technique over circular stapling.
本研究旨在对个别小型试验进行汇总分析，比较在病态肥胖手术中使用线性吻合器与圆形吻合器进行腹腔镜胃空肠（GJ）吻合术的效果。
对Medline、Embase和Cochrane图书馆数据库进行系统的文献检索。主要结局指标为GJ漏和狭窄。次要结局指标为手术时间、住院时间、术后出血、伤口感染、边缘溃疡和估计体重减轻。计算分类结局的合并比值比和连续结局的加权平均差。
纳入9项试验，共9374例患者（线性吻合2946例，圆形吻合6428例）。主要结局分析显示，圆形吻合器吻合相关的GJ狭窄发生率有统计学意义的增加。还发现线性吻合术相关的伤口感染、出血和手术时间显著降低。其他结局指标无显著差异。
这项汇总分析建议优先使用线性吻合技术而非圆形吻合技术。
