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Stapled versus hand-sewn intestinal anastomosis in pediatric patients: a systematic review and meta-analysis
Takayuki Fujii1, Aya Tanaka2, Hiroto Katami2
1Department of Pediatric Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Mikicho, 761-0793, Kitagun, Kagawa, Japan. fujii.takayuki@kagawa-u.ac.jp.
Insights
Stapled anastomosis (SA) is comparable to hand-sewn anastomosis (HA) in pediatric patients regarding complication rates. SA demonstrated shorter operative times, particularly in infants, suggesting it may be a viable option for intestinal anastomosis in children.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Techniques
Background:
- The safety of stapled anastomosis (SA) is established in adults, but its efficacy in pediatric patients remains unclear.
- This study addresses the need to evaluate SA versus hand-sewn anastomosis (HA) in children.
Purpose of the Study:
- To systematically review and meta-analyze the safety and effectiveness of stapled anastomosis (SA) compared to hand-sewn anastomosis (HA) in pediatric patients.
- To compare key outcomes including anastomotic leakage, stricture, and overall complication rates.
Main Methods:
- A systematic literature search was conducted across PubMed, Cochrane Library, and Scopus.
- Included studies compared SA and HA in children under 7 years, with subgroup analysis for those under 1 year.
- Statistical analysis involved calculating odds ratios and mean differences with 95% confidence intervals, assessing heterogeneity with I² statistic.
Main Results:
- No significant differences were found in anastomotic leakage, stricture, ileus, or overall anastomosis-related complications between SA and HA.
- Operative time was significantly shorter with SA compared to HA in infants (<1 year).
- Time to full feeding showed no significant difference between the two techniques.
Conclusions:
- Stapled anastomosis (SA) is comparable to hand-sewn anastomosis (HA) in terms of overall complication rates in pediatric patients.
- SA offers a shorter operative time, especially in infants, and may be a suitable alternative for intestinal anastomosis in children.
- Further evidence is needed to fully establish SA's role in pediatric intestinal anastomosis.
Background:
The safety and feasibility of stapled intestinal anastomosis have been widely reported in adults. However, the efficacy of stapled anastomosis (SA) in children is unclear. The aim of this study was to perform a systematic review and meta-analysis to evaluate the safety and effectiveness of SA compared with hand-sewn anastomosis (HA) in pediatric patients.
Methods:
A systematic literature search was performed using PubMed, the Cochrane Library, and Scopus databases. Studies comparing outcomes of children aged < 7 years and subgroups of children aged < 1 year who underwent SA or HA were included. Primary outcomes were anastomotic leakage and anastomotic stricture. Mean differences (MDs) with 95 % confidence intervals (CIs) were calculated for continuous variables. Odds ratios (ORs) with 95 % CIs were calculated for dichotomous variables. Interstudy heterogeneity was assessed using the chi-squared test and was quantified using the I² statistic.
Results:
One randomized control trial and five retrospective cohort studies, comprising 633 cases (229 SA cases and 404 HA cases), were included. No significant differences were observed in anastomotic leakage (6.5 % vs. 7.4 %; OR, 0.93; 95 % CI, 0.37-2.34; p = 0.88), anastomotic stricture (4.1 % vs. 9.3 %; OR, 0.54; 95 % CI, 0.19-1.51; p = 0.24), ileus (7.1 % vs. 9.3 %, OR, 2.35; 95 % CI, 0.15-37.51; p = 0.54), anastomosis-related complications (9.5 % vs. 10.9 %, OR, 0.98; 95 % CI, 0.52-1.86; p = 0.96; I2 = 39 %), and time until full-feeding (MD = -3.57 days; 95 % CI, -11.36 to 4.23; p = 0.37) between SA and HA. Operative time was significantly shorter in SA than in HA in children aged < 1 year (MD = -20.36 min; 95 % CI, -26.13 to -14.59).
Conclusions:
SA required shorter operative time and was comparable to HA in the overall complication rate. Although the evidence was insufficient, SA could be an option for intestinal anastomosis in children.
