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Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques
Jana Steger1, Alissa Jell1,2, Stefanie Ficht3
1Technical University of Munich, TUM School of Medicine, Chair of Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Munich, Germany.
Therapeutics and Clinical Risk Management
|May 13, 2022
Summary
Current gastrointestinal anastomosis techniques and implants require improvement for trauma minimization. Further innovation is needed to reduce complications and enable less invasive surgical interventions.
Area of Science:
- Gastrointestinal Surgery
- Surgical Implants
- Minimally Invasive Surgery
Background:
- Anastomosis creation is a critical step in resective gastrointestinal surgery.
- Existing techniques and implants are evaluated for their effectiveness in clinical practice.
- Focus is placed on their potential to minimize surgical trauma in visceral surgery.
Purpose of the Study:
- To review current techniques and implants for gastrointestinal anastomosis.
- To analyze their suitability for clinical needs and trauma minimization.
- To identify areas for improvement in visceral surgery.
Main Methods:
- Multi-database research (MEDLINE, Scopus, Cochrane Library).
- Inclusion of comparative controlled and uncontrolled clinical trials on intestinal anastomosis.
- Statistical assessment of postoperative complication incidences using Review Manager 5.4.
Main Results:
- Analysis of techniques and implants across four dimensions: performance and trauma reduction potential.
- Assessment of outcomes: leakage, stenosis, reoperation, mortality, bleeding, infections, abscesses, hemorrhages, embolisms, fistulas.
- Hand-suture anastomoses showed statistically significant superiority only in reducing obstructions compared to stapling.
Conclusions:
- No current anastomosis system sufficiently meets the demands for operative trauma minimization.
- Challenges include lack of standardization, high force requirements, and device design limitations.
- Innovative technologies, particularly for incisionless interventions, are needed.
