Comparison of Hand-Sewn and Stapled Esophagogastric Anastomoses: A Meta-Analysis

Objective To investigate the impact of hand-sewn and stapled esophagogastric anastomoses on postoperative mortality, anastomostic leak and fibrosis stricture. Methods Such databases as PubMed and Central Register of Controlled Trials （from the date of their establishments to February 2012） were searched. Eligible studies accessed the postoperative complications after hand-sewn and stapled esophagogastric anastomoses of which randomized control trials were collected. Quality assessment and data extraction were performed in those clinical trials. RevMan 5.0 software was applied to carry out the meta-analysis. Results Eleven relevant studies with 1 207 patients were included. All the studies were prospective but unblinded because of performing surgery. There were 8 studies with Jadad score 4, and 3 studies with Jadad score 3. Eleven studies reported the incidence of anastomostic leak, no significant heterogeneity between the 11 trials and fixed model was used to analysis. The combined OR=1.07, 95%CI 0.67~1.73, P=0.77. There was no statistically difference between the incidences of postoperative anasotmostic leaks. Ten studies reported the incidence of anastomostic stricture, the combined OR=2.20,95%CI 1.54~3.15, P<0.01. The incidence of postoperative anasotmostic stricture in circular stapled anastomoses patients was statistically higher than that in hand-sewn anastomosed patients. Seven studies reported the postoperative mortality. The combined OR=1.29, 95%CI 0.59~2.85, P=0.52. There was no statistically difference between the mortality. Only one study compared side-side anastomosis and reported a lower incidence of postoperative anastomostic leak and stricture. No obvious publication bias existed. Conclusion Circular stapled esophagogastric anastomoses increased the incidence of postoperative anastomostic stricture comparing with the hand-sewn anastomosed.