Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis

• Published in: The American journal of surgery Vol. 223; no. 5; pp. 884 - 892
• Main Authors: Milone, Marco, Elmore, Ugo, Manigrasso, Michele, Vertaldi, Sara, Aprea, Giovanni, Servillo, Giuseppe, Parise, Paolo, De Palma, Giovanni Domenico, Rosati, Riccardo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022; Elsevier Limited
• Subjects: Anastomosis; Anastomosis, Surgical - methods; Bias; Body mass index; Complications; Constriction, Pathologic - surgery; Demographic variables; Gastrectomy; Gastrectomy - methods; Gastric cancer; Gastrointestinal surgery; Gender; Heterogeneity; Humans; Laparoscopic gastrectomy; Laparoscopy; Laparoscopy - methods; Length of stay; Meta-analysis; Oesophagojejunostomy; Postoperative; Regression analysis; Retrospective Studies; Stapler; Stenosis; Stomach Neoplasms - surgery; Subgroups; Surgical Stapling - methods; Tumors; Variables; Laparoscopic gastrectomy; Stapler; Gastric cancer; Oesophagojejunostomy; Meta-analysis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.09.024

To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy. A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients’ number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results. 12 articles were included in the final analysis. A significant difference was observed in terms of “overall anastomotic complications” in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies. Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions. •The best anastomotic technique after laparoscopic total gastrectomy is not clear.•This systematic review with meta-analysis try to clarify whether side-to-side oesophagojejunal anastomosis is better than end-to-end.•Studies showed a significant difference in terms of “overall anastomotic complications” in favour of linear stapling.•Linear stapler seems to be related with lesser number of complication if compared with circular stapler.