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Stapled versus hand-sewn intestinal anastomosis in pediatric surgery: A systematic review and meta-analysis
Muhammad Meeran Saleem1, Areeba Ahsan1, Abia Shariq1
1DOW Medical College, Dow University of Health Sciences, Karachi, Pakistan.
Insights
Stapled anastomosis (SA) in pediatric surgery is as safe as hand-sewn anastomosis (HA), reducing operative time and speeding up feeding recovery. Further trials are needed for broader application.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Techniques
Background:
- Intestinal anastomosis is crucial for pediatric gastrointestinal conditions.
- Stapled anastomosis (SA) may enhance operative efficiency but its pediatric safety is unclear.
- This meta-analysis compares SA and hand-sewn anastomosis (HA) in children.
Purpose of the Study:
- To compare the safety and effectiveness of stapled anastomosis versus hand-sewn anastomosis in pediatric intestinal surgery.
- To evaluate key clinical outcomes including operative time, feeding recovery, and complications.
Main Methods:
- Systematic literature search following PRISMA guidelines.
- Inclusion of studies on children under 7 undergoing SA or HA.
- Risk-of-bias assessment and random-effects meta-analysis.
Main Results:
- SA significantly reduced operative time (mean difference -19.26 min) and accelerated oral feeding initiation (mean difference -2.32 days).
- No significant differences were observed in anastomotic leakage, stricture, reoperation rates, or hospital stay.
- Analysis included 11 studies with 903 pediatric patients.
Conclusions:
- Stapled anastomosis is a safe alternative to hand-sewn techniques in pediatric intestinal surgery.
- SA offers benefits of shorter operative duration and faster feeding recovery.
- Selective use of SA is supported, pending further multicenter randomized trials.
Background:
Intestinal anastomosis is a core procedure in pediatric gastrointestinal surgery, performed for conditions such as necrotizing enterocolitis, intestinal atresia, Hirschsprung's disease, and inflammatory bowel disease. Although stapled anastomosis (SA) may improve operative efficiency, its safety and effectiveness compared with hand-sewn anastomosis (HA) in children remain uncertain. This meta-analysis compared clinical outcomes of SA and HA in pediatric patients.
Methods:
The study followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251177257). A systematic search of PubMed, Dimensions, and the Cochrane Library was conducted through June 2025. Studies including children under 7 years undergoing intestinal SA or HA were eligible. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using ROB 2 and ROBINS-I tools. Statistical analysis was conducted using Comprehensive Meta-Analysis software (v3) with a random-effects model.
Results:
Eleven studies involving 903 patients met inclusion criteria, including two randomized controlled trials. Of these, 333 patients underwent SA and 570 underwent HA. SA was associated with significantly shorter operative time (mean difference [MD] = -19.26 min; 95% CI: -24.24 to -14.28; p < 0.001) and earlier initiation of oral feeding (MD = -2.32 days; 95% CI: -3.78 to -0.86; p = 0.002). No significant differences were found in anastomotic leakage, stricture formation, reoperation rate, or length of hospital stay.
Conclusions:
Stapled anastomosis appears as safe as hand-sewn techniques in pediatric intestinal surgery while offering shorter operative duration and faster postoperative feeding recovery. Selective use of stapled techniques is supported when anatomically feasible, though further multicenter randomized trials are needed.
