Association Between Cross-Stapling Technique in Mechanical Colorectal Anastomosis and Short-term Outcomes.

IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Diseases of the Colon & Rectum Pub Date : 2024-10-01 Epub Date: 2024-06-26 DOI:10.1097/DCR.0000000000003382
Francesco Guerra, Diego Coletta, Giuseppe Giuliani, Giulia Turri, Corrado Pedrazzani, Andrea Coratti
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引用次数: 0

Abstract

Background: The double-stapled technique is the most common method of colorectal anastomosis in minimally invasive surgery. Several modifications to the conventional technique have been described to reduce the intersection between the stapled lines, as the resulting lateral dog-ears are considered possible risk factors for anastomotic leakage.

Objective: This study aimed to analyze the outcomes of patients receiving conventional versus modified stapled colorectal anastomosis after minimally invasive surgery.

Data sources: A systematic review of the published literature was undertaken. PubMed/MEDLINE, Web of Science, and Embase databases were screened up to July 2023.

Study selection: Relevant articles were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles reporting on the outcomes of patients with modified stapled colorectal reconstruction compared with the conventional method of double-stapled anastomosis were included.

Interventions: Conventional double-stapling colorectal anastomosis and modified techniques with reduced intersection between the stapled lines were compared.

Main outcome measures: The rate of anastomotic leak was the primary end point of interest. Perioperative details including postoperative morbidity were also appraised.

Results: There were 2537 patients from 12 studies included for data extraction, with no significant differences in age, BMI, or proportion of high ASA score between patients who had conventional versus modified techniques of reconstructions. The risk of anastomotic leak was 62% lower for the modified procedure than for the conventional procedure (OR = 0.38 [95% CI, 0.26-0.56]). The incidences of overall postoperative morbidity (OR = 0.57 [95% CI, 0.45-0.73]) and major morbidity (OR = 0.48 [95% CI, 0.32-0.72]) following modified stapled anastomosis were significantly lower than following conventional double-stapled anastomosis.

Limitations: The retrospective nature of most included studies is a main limitation, essentially because of the lack of randomization and the risk of selection and detection bias.

Conclusions: The available evidence supports the modification of the conventional double-stapled technique with the elimination of 1 of both dog-ears as it is associated with a lower incidence of anastomotic-related morbidity.

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机械性结直肠吻合术中交叉缝合技术与短期疗效的关系
背景:双钉技术是微创手术中最常用的结直肠吻合方法。传统技术的几种改良方法旨在减少订书线之间的交叉,因为由此产生的侧狗耳被认为是吻合口漏的可能风险因素:本研究旨在分析微创手术后接受传统与改良订书机结直肠吻合术的患者的疗效:对已发表的文献进行了系统回顾。研究选择:根据《系统综述和荟萃分析首选报告项目》指南检索了相关文章。纳入了报告改良订书钉结肠直肠重建术与传统双订书钉吻合术相比患者疗效的文章:干预措施:比较传统的双缝合结直肠吻合术和减少缝合线交叉的改良技术:主要结果测量:吻合口漏率是主要关注终点。主要结果测量指标:吻合口漏率是研究的主要终点,围手术期细节包括术后发病率也在评估之列:结果:12 项研究共纳入 2537 名患者进行数据提取,采用传统与改良重建技术的患者在年龄、体重指数和美国麻醉医师协会高分比例方面无明显差异。与传统手术相比,改良手术的吻合口漏风险降低了 62%(几率比 = 0.38 [95% CI:0.26, 0.56])。术后总发病率(几率比=0.57 [95% CI:0.45, 0.73])和主要发病率(几率比=0.48 [95% CI:0.32, 0.72])明显低于传统的双层缝合吻合术:局限性:大多数纳入研究的回顾性是主要局限性,主要原因是缺乏随机化,存在选择和检测偏倚的风险:现有证据支持对传统双层缝合技术进行修改,去掉其中一个狗耳,因为这与吻合相关的发病率较低有关。
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来源期刊
CiteScore
4.50
自引率
7.70%
发文量
572
审稿时长
3-8 weeks
期刊介绍: Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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