Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain.
Tech Coloproctol. 2020 Sep;24(9):919-925. doi: 10.1007/s10151-020-02240-7. Epub 2020 May 25.
Several univariate and multivariate studies have already identified the number of stapler firings for laparoscopic rectal transection for rectal cancer as an independent risk factor for anastomotic leakage. The aim of this study was to perform a systematic review and meta-analysis of the anastomotic leakage rate in laparoscopic rectal surgery according to the need of using one or two stapler firings for rectal transection.
PubMed, Ovid, the Cochrane Library database and ClinicalTrials.gov were searched. All of the statistical analyses were performed using Revman software.
Five studies were included (1267 patients). The overall anastomotic leakage rate was 5.5% [0.7-8.4%]. Anastomotic leak occurred in 3.5% (17/491) of the cases where 1 stapler firing was used versus 6.7% (50/786) of the cases in which 2 firings were needed (50/786). Two stapler firings were significantly associated with an increased risk of anastomotic leakage (OR 2.44, 95% CI 1.34-4.42, p = 0.003, I = 1%).
Our systematic review and meta-analysis suggest that two firings imply a higher rate of anastomotic leak than a single firing after laparoscopic rectal surgery with a double stapling technique. Coloproctologists should strive to reduce the number of linear stapler firings and try to transect the rectum with a single firing.
几项单变量和多变量研究已经确定，用于腹腔镜直肠切除直肠癌的吻合器击发次数是吻合口漏的独立危险因素。本研究旨在对腹腔镜直肠手术中根据直肠横断需要使用一次或两次吻合器击发来评估吻合口漏发生率进行系统评价和荟萃分析。
检索了 PubMed、Ovid、Cochrane 图书馆数据库和 ClinicalTrials.gov。所有的统计分析均使用 Revman 软件进行。
共纳入 5 项研究（1267 例患者）。总的吻合口漏发生率为 5.5%[0.7-8.4%]。使用 1 次吻合器击发时吻合口漏发生率为 3.5%（17/491），使用 2 次吻合器击发时吻合口漏发生率为 6.7%（50/786）。2 次吻合器击发与吻合口漏风险增加显著相关（OR 2.44，95%CI 1.34-4.42，p=0.003，I=1%）。
我们的系统评价和荟萃分析表明，与使用双吻合器技术行腹腔镜直肠手术后单次吻合器击发相比，两次吻合器击发会导致更高的吻合口漏发生率。结直肠外科医生应努力减少吻合器击发次数，并尝试通过单次击发来横断直肠。
