Only studies that had compared stapled and hand-sewn anastomosis, with or without bowel resection, were included in the analysis. All full articles were obtained for the included studies. Two authors independently assessed the titles and abstracts of the identified studies. The reference lists in the identified studies were also searched in order to identify further studies. The databases used for the literature search included MEDLINE, EMBASE, and Cochrane Controlled Trials Register. Systematic search strategies was used to identify the relevant studies and electronic search was performed. The primary endpoint was anastomotic leak and the secondary endpoint included bowel obstruction, wound infection, bleeding, operating time, time to first defecation, length of hospital stay, re-admission, re-operation and 30 days operative mortality. There was only one study with more than 1,000 participants. One study was a prospective non-randomised and one was a retrospective analysis of a prospective database. There were only 4 randomised control trials in the literature. All relevant studies were considered, irrespective of language and publication status, for this review. MethodsĪll published randomised controlled trials and quasi-randomised controlled trials comparing stapled and hand-sewn closure of loop ileostomy were eligible for inclusion. This review aims to compare stapled versus hand-sewn anastomoses with regard to all documented parameters of perioperative morbidity in addition to looking at the effects of small-bowel resection on anastomotic leak and bowel obstruction. A systematic review, with a pooled analysis of results, might provide a more definitive answer.Īlthough systematic reviews on this topic already exist in the literature, none of them has looked into the effect of small-bowel resection during the ileostomy reversal procedure. Individual trials comparing hand-sewn with stapled closure of loop ileostomy showed different outcomes, perhaps because they lacked statistical power. The side-to-side stapler anastomosis for closure of ileostomy was introduced into practice in the 1980s. The traditional method for reversing a loop ileostomy involved a hand-sewn end-to-end bowel anastomosis. Once the anastomosis has healed or a fistula successfully repaired, the loop ileostomy may be closed. It can also be used as a diversion in severe fistulating perianal Crohn’s disease. The most common conditions where a loop ileostomy may be used include resections for rectal cancer, ulcerative colitis, diverticular disease and familial adenomatous polyposis. This technique is primarily used to facilitate the healing of a low colorectal anastomosis to diminish the consequences of an anastomotic leak. Performance of bowel resection does not significantly increase the incidence of anastomotic leak or small-bowel obstruction.Ī defunctioning loop ileostomy is a commonly used surgical procedure to allow faecal diversion from a distal anastomosis. The rate of small-bowel obstruction was higher in the hand-sewn group. Conclusions: There was no significant difference in the rate of anastomotic leakage between the hand-sewn and stapled techniques. There was no difference in the incidence of anastomotic leak and small-bowel obstruction in the hand-sewn anastomosis between patients with or without bowel resection. Results: Of the 4,917 patients in 15 identified studies, 3,406 had hand-sewn and 1,511 stapled anastomosis. All randomised clinical trials, prospective and retrospective studies comparing hand-sewn with stapled closure of loop ileostomy were included. Methodology: Relevant studies were identified from MEDLINE, EMBASE and the Cochrane database. This review aimed to compare hand-sewn with stapled anastomotic technique for closure of a loop ileostomy and looked at the effect of bowel resection on the complication rates. A systematic review, with a pooled analysis of results, might provide a more definitive answer. Background: Individual trials comparing hand-sewn with stapled closure of loop ileostomy show different outcomes due to lack of statistical power.
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