Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Department of Surgery, Woodlands Health, Singapore, Singapore.
Langenbecks Arch Surg. 2024 Oct 31;409(1):331. doi: 10.1007/s00423-024-03490-x.
The growing use of staplers, manual and powered, especially in minimally invasive surgeries, necessitates evaluating their efficacy in gastrointestinal and thoracic surgeries. Parameters analysed include anastomotic and air leakage rates, bleeding, infection, cost, and operative duration.
We searched Cochrane Library, CINAHL, EMBASE, PubMed, and Web of Science using terms like "surgical staplers," "manual staplers," "automatic staplers," and "powered staplers." We assessed study quality using the Joanna Briggs Institute (JBI) Critical Appraisal tools and conducted meta-analysis using Review Manager software.
A total of 43,104 patients with a mean age of 60.8 were involved in the studies. The meta-analysis revealed a significant reduction in anastomotic leaks in GI surgery patients (OR 0.31, p = 0.0001) and a significant decrease in postoperative air leakage in thoracic surgery patients (OR 0.65, p = 0.05) when powered staplers were employed. Additionally, we observed a significant decline in hemostasis-related complications for both thoracic and GI surgeries (OR 0.48, p = 0.002) with the use of powered staplers. Although individually costlier than manual staplers, powered staplers significantly decreased total hospitalisation costs (MD -1725.82, p < 0.00001) amoungst the thoracic surgeries, due to the cost saved on remedying the lower rate of complications compared to manual staplers. It also decreased the average operative times in thoracic and GI surgeries, although not significant (p = 0.06, p = 0.07 respectively).
Powered staplers surpass manual staplers by reducing operative duration, total hospital costs, and complications like anastomotic leaks and bleeding. Hence, they are poised to become the preferred alternative in future surgeries.
随着吻合器（手动和电动）的广泛应用，尤其是在微创手术中，有必要评估其在胃肠和胸外科手术中的效果。分析的参数包括吻合口漏和空气漏率、出血、感染、成本和手术时间。
我们使用“外科吻合器”、“手动吻合器”、“自动吻合器”和“动力吻合器”等术语，在 Cochrane Library、CINAHL、EMBASE、PubMed 和 Web of Science 中进行了检索。我们使用 Joanna Briggs 研究所（JBI）的批判性评估工具评估了研究质量，并使用 Review Manager 软件进行了荟萃分析。
共有 43104 名平均年龄为 60.8 岁的患者参与了这些研究。荟萃分析显示，在胃肠外科手术患者中，动力吻合器可显著降低吻合口漏的发生率（OR 0.31，p=0.0001），在胸外科手术患者中，可显著降低术后空气漏的发生率（OR 0.65，p=0.05）。此外，我们观察到在使用动力吻合器时，胸外科和胃肠外科的止血相关并发症均显著减少（OR 0.48，p=0.002）。尽管动力吻合器比手动吻合器单独成本更高，但由于与手动吻合器相比，并发症发生率降低，从而显著降低了胸外科的总住院费用（MD -1725.82，p<0.00001）。它还缩短了胸外科和胃肠外科的平均手术时间，尽管差异无统计学意义（p=0.06，p=0.07）。
动力吻合器通过缩短手术时间、总住院费用和减少吻合口漏和出血等并发症，优于手动吻合器。因此，它们有望成为未来手术的首选。
