Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Surgery. 2024 Sep;176(3):633-644. doi: 10.1016/j.surg.2024.04.039. Epub 2024 Jun 13.
Some observational data have suggested that anastomotic leak may be reduced with triple-row staple technology compared to double-row staple technology. We aimed to investigate this further by performing a systematic review comparing double- and triple-row staple technology for colorectal anastomoses.
This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to November 2023. Articles were eligible for inclusion if they were comparing double-row staple and triple-row staple technology for left-sided colo-colic, colorectal, or coloanal anastomosis. The main outcomes included anastomotic leak, anastomotic hemorrhage, 30-day mortality, and reoperation. Meta-analyses with inverse variance random effects were performed. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development, and Evaluations.
After reviewing 340 relevant citations, 6 retrospective cohort studies met inclusion. Overall, 19,372 patients (mean age: 60.2 years, 52.7% female sex) had anastomoses with double-row staple technology, and 2,298 patients (mean age: 61.3 years, 50.3% female sex) with triple-row staple technology. Most operations were anterior resections (double-row: 55.3%; triple-row: 43.6%). Across all included studies, the risk of anastomotic leak was reduced with triple-row staple technology (6.3% vs 7.5%, risk ratio 0.54, 95% confidence interval 0.31-0.94, P = .03, I=75%). There were no significant differences in anastomotic hemorrhage (risk ratio 0.47, 95% confidence interval 0.15-1.49, P = .20, I = 57%), 30-day mortality (risk ratio 0.66, 95% confidence interval 0.17-2.55, P = .55, I = 0%), or reoperation (risk ratio 1.05, 95% confidence interval 0.42-2.64, P = .91, I = 56%).
Triple-row staple technology may reduce the risk of anastomotic leak in left-sided colorectal anastomoses.
一些观察性数据表明，与双排钉技术相比，三排钉技术可能降低吻合口漏的风险。我们旨在通过系统评价进一步研究这一点，比较左半结肠-结肠、结直肠或结肠直肠吻合中使用双排钉和三排钉技术的情况。
本系统评价按照系统评价和荟萃分析的首选报告项目进行报告。截至 2023 年 11 月，检索了 MEDLINE、Embase 和 Cochrane 对照试验中心注册库。如果文章比较了左半结肠-结肠、结直肠或结肠直肠吻合中使用双排钉和三排钉技术，则符合纳入标准。主要结局包括吻合口漏、吻合口出血、30 天死亡率和再次手术。采用逆方差随机效应进行荟萃分析。使用推荐评估、制定和评估分级来评估证据的确定性。
在回顾了 340 篇相关引文后，有 6 项回顾性队列研究符合纳入标准。共有 19372 例患者（平均年龄：60.2 岁，52.7%为女性）接受了双排钉技术吻合，2298 例患者（平均年龄：61.3 岁，50.3%为女性）接受了三排钉技术吻合。大多数手术为前切除术（双排钉：55.3%；三排钉：43.6%）。在所有纳入的研究中，三排钉技术可降低吻合口漏的风险（6.3%比 7.5%，风险比 0.54，95%置信区间 0.31-0.94，P=0.03，I=75%）。吻合口出血（风险比 0.47，95%置信区间 0.15-1.49，P=0.20，I=57%）、30 天死亡率（风险比 0.66，95%置信区间 0.17-2.55，P=0.55，I=0%）或再次手术（风险比 1.05，95%置信区间 0.42-2.64，P=0.91，I=56%）无显著差异。
三排钉技术可能降低左半结肠吻合中吻合口漏的风险。
