Stapled versus handsewn methods for ileocolic anastomoses

Background: This is the first systematic review specifically investigating ileocolic anastomosis. Objectives: To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. The hypothesis tested was that the stapling technique is associated with fewer complications. Search strategy: MEDLINE, EMBASE, Cochrane Colorectal Cancer Group specialised register SR-COLOCA, and Cochrane Library were searched for randomised controlled trials comparing the use of a linear cutter stapler with any type of suturing technique for ileocolic anastomoses in adults from 1970 to 2005. Selection criteria were randomised controlled trials comparing the use of linear cutter stapler (isoperistaltic side to side or functional end to end) with any type of suturing technique in adults. Regarding data collection and analysis, eligible studies were selected and their methodological quality assessed. Sub-group analyses for cancer and inflammatory bowel disease as indication for ileocolic anastomoses were performed. Results: Six trials (including one unpublished) with 955 ileocolic participants were included. The three largest trials had adequate allocation concealment. Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with the handsewn technique (S = 5/357, HS = 36/598, OR 0.34 [0.14, 0.82] p = 0.02). For the sub-group of 825 cancer patients in four studies, stapled anastomosis led to significantly fewer anastomotic leaks (S = 4/300, HS = 35/525, OR 0.28 [0.10, 0.75] p = 0.01). There were very less Crohn’s disease patients to perform a sub-group analysis. All other outcomes showed no significant difference. Conclusions: Stapled functional end-to-end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis.