Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
Department of Robotic Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Cancer Control. 2024 Jan-Dec;31:10732748241236338. doi: 10.1177/10732748241236338.
This systematic review and meta-analysis aimed to compare outcomes between stapled ileal pouch-anal anastomosis (IPAA) and hand-sewn IPAA with mucosectomy in cases of ulcerative colitis and familial adenomatous polyposis.
This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines 2020 and AMSTAR 2 (Assessing the methodological quality of systematic reviews) guidelines. We included randomized clinical trials (RCTs) and controlled clinical trials (CCTs). Subgroup analysis was performed according to the indication for surgery.
The bibliographic research yielded 31 trials: 3 RCTs, 5 prospective clinical trials, and 24 CCTs including 8872 patients: 4871 patients in the stapled group and 4038 in the hand-sewn group. Regarding postoperative outcomes, the stapled group had a lower rate of anastomotic stricture, small bowel obstruction, and ileal pouch failure. There were no differences between the 2 groups in terms of operative time, anastomotic leak, pelvic sepsis, pouchitis, or hospital stay. For functional outcomes, the stapled group was associated with greater outcomes in terms of seepage per day and by night, pad use, night incontinence, resting pressure, and squeeze pressure. There were no differences in stool Frequency per 24h, stool frequency at night, antidiarrheal medication, sexual impotence, or length of the high-pressure zone. There was no difference between the 2 groups in terms of dysplasia and neoplasia.
Compared to hand-sewn anastomosis, stapled ileoanal anastomosis leads to a large reduction in anastomotic stricture, small bowel obstruction, ileal pouch failure, seepage by day and night, pad use, and night incontinence. This may ensure a higher resting pressure and squeeze pressure in manometry evaluation.
The protocol was registered at PROSPERO under CRD 42022379880.
本系统评价和荟萃分析旨在比较溃疡性结肠炎和家族性腺瘤性息肉病患者行吻合器吻合与手工吻合加黏膜切除术的直肠储袋肛管吻合术（IPAA）的结局。
本系统评价和荟萃分析根据 2020 年《系统评价和荟萃分析首选报告项目》（PRISMA）和 AMSTAR 2（系统评价方法学质量评估）指南进行。我们纳入了随机临床试验（RCT）和对照临床试验（CCT）。根据手术适应证进行亚组分析。
文献研究产生了 31 项试验：3 项 RCT、5 项前瞻性临床试验和 24 项 CCT，共纳入 8872 例患者：吻合器组 4871 例，手工组 4038 例。在术后结果方面，吻合器组吻合口狭窄、小肠梗阻和直肠储袋失败的发生率较低。两组在手术时间、吻合口漏、骨盆脓毒症、储袋炎或住院时间方面无差异。在功能结局方面，吻合器组在每天和每晚渗漏、使用尿垫、夜间失禁、静息压和收缩压方面的结局更好。两组在 24 小时排便次数、夜间排便次数、止泻药物使用、性勃起功能障碍或高压区长度方面无差异。两组在发育不良和肿瘤方面无差异。
与手工吻合相比，吻合器吻合可显著降低吻合口狭窄、小肠梗阻、直肠储袋失败、白天和夜间渗漏、使用尿垫和夜间失禁的发生率。这可能确保在测压评估中获得更高的静息压和收缩压。
该方案在 PROSPERO 中根据 CRD 42022379880 进行了注册。
