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01-02-2015 | Systematic Review and Meta-analysis

Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials

Authors: Thorsten Löffler, Inga Rossion, Käthe Gooßen, Daniel Saure, Jürgen Weitz, Alexis Ulrich, Markus W. Büchler, Markus K. Diener

Published in: Langenbeck's Archives of Surgery | Issue 2/2015

Abstract

Purpose

The aims of this study are to compare the 30-day rate of bowel obstruction for stapled vs. handsewn closure of loop ileostomy, and to further assess efficacy and safety for each technique by secondary endpoints such as operative time, rates of anastomotic leakage, and other post-operative complications within 30 days.

Methods

A systematic literature search (MEDLINE, The Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomized controlled trials (RCTs) comparing stapled and handsewn closure of loop ileostomy after low anterior resection. Random effects meta-analyses were calculated and presented as risk ratio (RR) and mean difference (MD) with corresponding 95 % confidence intervals.

Results

Forty publications were retrieved and 4 RCTs (649 patients) were included. There was methodological and clinical heterogeneity of included trials, but statistical heterogeneity was low for most endpoints. Stapler use significantly reduced the rate of bowel obstruction compared to hand-sewn closure (RR 0.53 [0.32, 0.88]; P = 0.01). The operation time was significantly lower for stapling compared to hand suture (MD −15.5 min [−18.4, 12.6]; P < 0.001). All other secondary outcomes did not show significant differences.

Conclusions

This meta-analysis shows superiority of stapled closure of loop ileostomy compared to handsewn closure in terms of bowel obstruction rate and mean operation time. Other relevant complications such as anastomotic leakage are equivalent. Even so, both techniques are options with opposing advantages and disadvantages.

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Title: Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials
Authors: Thorsten Löffler
Inga Rossion
Käthe Gooßen
Daniel Saure
Jürgen Weitz
Alexis Ulrich
Markus W. Büchler
Markus K. Diener
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1265-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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