Steger Jana, Jell Alissa, Ficht Stefanie, Ostler Daniel, Eblenkamp Markus, Mela Petra, Wilhelm Dirk
Technical University of Munich, TUM School of Medicine, Chair of Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Munich, Germany.
Technical University of Munich, TUM School of Medicine, Clinic and Polyclinic for Surgery, Munich, Germany.
Ther Clin Risk Manag. 2022 May 4;18:523-539. doi: 10.2147/TCRM.S335102. eCollection 2022.
Anastomosis creation after resective gastrointestinal surgery is a crucial task. The present review examines the techniques and implants currently available for anastomosis creation and analyses to which extent they already address our clinical needs, with a special focus on their potential to enable further trauma minimization in visceral surgery.
A multi-database research was conducted in MEDLINE, Scopus, and Cochrane Library. Comparative controlled and uncontrolled clinical trials dealing with anastomosis creation techniques in the intestinal tract in both German and English were included and statistically significant differences in postoperative complication incidences were assessed using the RevMan5.4 Review Manager (Cochrane Collaboration, Oxford, UK).
All methods and implant types were analyzed and compared with respect to four dimensions, assessing the techniques' current performances and further potentials for surgical trauma reduction. Postoperative outcome measures, such as leakage, stenosis, reoperation and mortality rates, as well as the tendency to cause bleeding, wound infections, abscesses, anastomotic hemorrhages, pulmonary embolisms, and fistulas were assessed, revealing the only statistically significant superiority of hand-suture over stapling anastomoses with respect to the occurrence of obstructions.
Based on the overall complication rates, it is concluded that none of the anastomosis systems addresses the demands of operative trauma minimization sufficiently yet. Major problems are furthermore either low standardization potentials due to dependence on the surgeons' levels of experience, high force application requirements for the actual anastomosis creation, or large and rigid device designs interfering with flexibility demands and size restrictions of the body's natural access routes. There is still a need for innovative technologies, especially with regard to enabling incisionless interventions.
在胃肠道切除术后进行吻合术是一项关键任务。本综述探讨了目前可用于创建吻合术的技术和植入物，并分析了它们在多大程度上满足了我们的临床需求，特别关注它们在减少内脏手术创伤方面的潜力。
在MEDLINE、Scopus和Cochrane图书馆进行了多数据库研究。纳入了以德语和英语进行的关于肠道吻合术创建技术的比较对照和非对照临床试验，并使用RevMan5.4综述管理器（英国牛津Cochrane协作网）评估术后并发症发生率的统计学显著差异。
对所有方法和植入物类型在四个维度上进行了分析和比较，评估了这些技术当前的性能以及进一步减少手术创伤的潜力。评估了术后结果指标，如渗漏、狭窄、再次手术和死亡率，以及引起出血、伤口感染、脓肿、吻合口出血、肺栓塞和瘘管的倾向，结果显示在梗阻发生率方面，手工缝合仅在统计学上显著优于吻合器吻合。
基于总体并发症发生率得出结论，目前尚无一种吻合系统能够充分满足将手术创伤降至最低的要求。此外，主要问题包括因依赖外科医生的经验水平而导致标准化潜力低、实际创建吻合术时对施加力的要求高，或者器械设计大且刚性，干扰了身体自然进入途径的灵活性要求和尺寸限制。仍然需要创新技术，特别是在实现无切口干预方面。
