Löffler Thorsten, Rossion Inga, Gooßen Käthe, Saure Daniel, Weitz Jürgen, Ulrich Alexis, Büchler Markus W, Diener Markus K
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Langenbecks Arch Surg. 2015 Feb;400(2):193-205. doi: 10.1007/s00423-014-1265-8. Epub 2014 Dec 25.
The aims of this study are to compare the 30-day rate of bowel obstruction for stapled vs. handsewn closure of loop ileostomy, and to further assess efficacy and safety for each technique by secondary endpoints such as operative time, rates of anastomotic leakage, and other post-operative complications within 30 days.
A systematic literature search (MEDLINE, The Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomized controlled trials (RCTs) comparing stapled and handsewn closure of loop ileostomy after low anterior resection. Random effects meta-analyses were calculated and presented as risk ratio (RR) and mean difference (MD) with corresponding 95 % confidence intervals.
Forty publications were retrieved and 4 RCTs (649 patients) were included. There was methodological and clinical heterogeneity of included trials, but statistical heterogeneity was low for most endpoints. Stapler use significantly reduced the rate of bowel obstruction compared to hand-sewn closure (RR 0.53 [0.32, 0.88]; P = 0.01). The operation time was significantly lower for stapling compared to hand suture (MD -15.5 min [-18.4, 12.6]; P < 0.001). All other secondary outcomes did not show significant differences.
This meta-analysis shows superiority of stapled closure of loop ileostomy compared to handsewn closure in terms of bowel obstruction rate and mean operation time. Other relevant complications such as anastomotic leakage are equivalent. Even so, both techniques are options with opposing advantages and disadvantages.
本研究旨在比较吻合器与手工缝合回肠袢式造口关闭术的30天肠梗阻发生率，并通过手术时间、吻合口漏发生率及30天内其他术后并发症等次要终点指标进一步评估每种技术的疗效和安全性。
进行系统的文献检索（MEDLINE、Cochrane图书馆、EMBASE和ISI科学网），以确定比较低位前切除术后回肠袢式造口吻合器与手工缝合关闭术的随机对照试验（RCT）。计算随机效应荟萃分析，并以风险比（RR）和平均差（MD）及相应的95%置信区间表示。
检索到40篇文献，纳入4项RCT（649例患者）。纳入试验存在方法学和临床异质性，但大多数终点指标的统计学异质性较低。与手工缝合相比，使用吻合器显著降低了肠梗阻发生率（RR 0.53 [0.32, 0.88]；P = 0.01）。吻合器缝合的手术时间显著低于手工缝合（MD -15.5分钟[-18.4, 12.6]；P < 0.001）。所有其他次要结局均未显示出显著差异。
这项荟萃分析表明，在肠梗阻发生率和平均手术时间方面，回肠袢式造口吻合器关闭术优于手工缝合关闭术。其他相关并发症如吻合口漏相当。即便如此，两种技术都各有优缺点，都是可选方案。
