New alternative colorectal anastomotic devices: A systematic review and meta-analysis.

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2024-12-07 DOI:10.1016/j.amjsurg.2024.116128

T Shakir, T Pampiglione, M Hassouna, P Rogers, J Dourado, S Emile, R Kokelaar, S Wexner

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Abstract

Background: Colorectal anastomotic devices have been used for nearly a century, with stapled anastomoses being the most common despite leak rates up to 20 %. This review aimed to evaluate newer alternative devices.

Method: A systematic review and meta-analysis of publications from the last decade were conducted, focusing on devices forming colorectal anastomoses, excluding those facilitating sutured or stapled anastomoses or designed to prevent leaks. Data from MEDLINE, Embase, Cochrane, and ClinicalTrials.gov were analysed.

Results: Eighteen studies (7 human, 10 animal, 1 ex-vivo) involving 955 anastomoses were included. Compression mechanisms were the most common. The pooled complication rate in human studies was 9.7 % (95 % CI: 4.3-15.2 %) with significant heterogeneity (I2 = 81.7 %). The leak rate after compression anastomoses was 3.3 % (95 % CI: 1.9-4.7 %) with no heterogeneity (I2 = 0 %). A novel device with transanal catheters allowed intraoperative and postoperative assessment.

Conclusions: Outcomes are comparable to existing methods, with new technologies offering promising advancements.

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新型替代性结直肠吻合器：系统回顾和荟萃分析。

背景：大肠吻合器已使用了近一个世纪，尽管泄漏率高达 20%，但订书钉吻合器是最常见的吻合器。本综述旨在评估更新的替代装置：方法：我们对过去十年间发表的文献进行了系统性回顾和荟萃分析，重点关注结直肠吻合器，排除了那些促进缝合或钉合吻合或旨在防止渗漏的吻合器。分析了来自 MEDLINE、Embase、Cochrane 和 ClinicalTrials.gov 的数据：结果：共纳入 18 项研究（7 项人体研究、10 项动物研究、1 项体外研究），涉及 955 个吻合口。最常见的是压迫机制。人类研究的合并并发症发生率为 9.7%（95% CI：4.3-15.2%），异质性显著（I2 = 81.7%）。压迫吻合术后的渗漏率为 3.3%（95% CI：1.9-4.7%），无异质性（I2 = 0%）。一种带有经肛门导管的新型设备可进行术中和术后评估：结果与现有方法相当，新技术有望带来进步。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.