Approach to enteric anastomotic technique has been a subject of debate, with no consensus as to whether handsewn or stapled techniques are superior in trauma. This review compares the risk of anastomotic complications in trauma patients with handsewn versus staples approaches.
A search Medline, Embase and Cochrane Central was performed. Studies evaluating stapled versus handsewn gastrointestinal anastomoses in trauma were included. All anastomoses involving small to small intestine, small to large intestine, and large to large intestine were eligible. Rectal anastomoses were excluded. Outcomes evaluated were (1) anastomotic leak (AL) (2) a composite anastomotic complication (CAC) end point consisting of AL, enterocutaneous fistula and deep abdominal abscess.
Eight studies involving 790 patients were analysed. There was no significant difference identified for AL between the two groups (OR = 0.77; 95% CI 0.24–2.45; P = 0.66). There was no significant improvement in CAC in the stapled anastomosis group (OR = 1.05; 95% CI 0.53–2.09; P = 0.90). Overall, there was limited evidence to suggest superiority with either approach for improving anastomotic outcomes, however this was based on studies of moderate to high risk of bias with poor control for confounders.
We demonstrate no superiority improvement in anastomotic outcomes with stapled or handsewn approach. These findings may represent no effect by technique for all situations. However, considering the paucity of information on potential confounders, perhaps there is a difference in outcome with overall technique or for specific subgroups that have not been described due to limited sample size and data on confounders.