Association Between Circular Stapler Diameter and Stricture Rates Following Gastrointestinal Anastomosis: Systematic Review and Meta-analysis

Allen, W. R.; Wells, Cameron I.; Greenslade, Marry; Bissett, Ian P.; O’Grady, Greg

doi:10.1007/s00268-018-4606-x

Cited by 20 publications

(20 citation statements)

References 67 publications

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“…[23][24][25][26][27][28] It was concluded that the use of larger circular stapler size (28 mm versus 25 mm) was strongly associated with a reduced risk of postoperative anastomotic strictures in the upper GI tract. 22 Results from our study do not support the conclusion of aforementioned meta-analysis, as there were no differences observed in anastomotic insufficiency and postoperative anastomotic strictures between the 25 mm and the 28 mm stapled esophagogastric anastomosis. The meta-analysis included 367 patients in the 25 mm and 460 patients in the 28 mm group (827 patients in total).…”

Section: Discussioncontrasting

confidence: 95%

“…The meta-analysis included 367 patients in the 25 mm and 460 patients in the 28 mm group (827 patients in total). 22 Our study included 349 patients (222 in the 25 mm group and 127 in the 28 mm group) and might significantly contribute (30% additional patients) evidence that there is no difference in postoperative outcomes between the two stapler diameters applied for a circular stapled intrathoracic anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there is only one meta-analysis, which compared different circular stapler diameters (25 mm versus 28 mm) to create the esophagogastric anastomosis. 22 In this meta-analysis, 5 observational studies were included. [23][24][25][26][27][28] It was concluded that the use of larger circular stapler size (28 mm versus 25 mm) was strongly associated with a reduced risk of postoperative anastomotic strictures in the upper GI tract.…”

Section: Discussionmentioning

confidence: 99%

“…24 This shows that our postoperative anastomotic stricture rates observed in our cohort were comparable to other high volume tertiary referral centers and reflect the incidence of postoperative anastomotic stricture rates in daily practice. 22,24 The size of the circular stapler (25 mm or 28 mm) as used in this study was chosen based on the size of the esophageal lumen after transection. Without a difference in the incidence of anastomotic insufficiency and postoperative anastomotic dilatations after esophagectomy, the surgeon could choose either the 25 mm or 28 mm circular stapler to restore continuity based on the estimation of the esophageal lumen.…”

Section: Discussionmentioning

confidence: 99%

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The Circular Stapled Esophagogastric Anastomosis in Esophagectomy: No Differences in Anastomotic Insufficiency and Stricture Rates Between the 25 mm and 28 mm Circular Stapler

Sluis

Uzun

Berlth

et al. 2021

Journal of Gastrointestinal Surgery

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Background For patients undergoing an Ivor Lewis esophagectomy with a circular stapled anastomosis, the optimal diameter of the used circular stapler to restore continuity is unknown. The aim of this study was to compare the 25 mm stapled versus the 28 mm stapled esophagogastric anastomosis after Ivor Lewis esophagectomy, focusing on anastomotic insufficiency and postoperative anastomotic strictures. Methods Between February 2008 and June 2019, 349 consecutive patients underwent Ivor Lewis esophagectomy with gastric conduit reconstruction and circular stapled anastomosis. Patient characteristics and postoperative results, such as anastomotic insufficiency rates, postoperative anastomotic stricture rates, time to anastomotic stricture rate, and the number of dilatations, were recorded in a prospective database and analyzed. Results In 222 patients (64%), the 25 mm circular stapler was used and in 127 patients (36%) the 28 mm circular stapler was used. There were no differences in baseline characteristics. Anastomotic insufficiency rates were comparable between the 25 mm (12%) and the 28 mm groups (11%) (p = 0.751). There were no differences between postoperative anastomotic strictures in the 25 mm (14%) and the 28 mm groups (14%) (p = 0.863). Within patients with postoperative anastomotic strictures, a median number of 2 dilatations were observed in each group (p = 0.573) without differences in the time to first diagnosis (p = 0.412). Conclusion There were no differences in anastomotic insufficiency and postoperative anastomotic stricture rates between the 25 mm and the 28 mm circular stapled esophagogastric anastomosis after Ivor Lewis esophagectomy. Both the 25 mm and 28 mm stapler can be safely used to create a circular stapled esophagogastric anastomosis to restore continuity after esophagectomy.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Circular Stapled Esophagogastric Anastomosis in Esophagectomy: No Differences in Anastomotic Insufficiency and Stricture Rates Between the 25 mm and 28 mm Circular Stapler

Sluis

Uzun

Berlth

et al. 2021

Journal of Gastrointestinal Surgery

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“…In this context, the anastomotic technique may have an impact on the incidence of dysphagia, as there is evidence of lower stricture rates after mechanical sideto-side anastomosis compared with circular stapler or manual suture anastomosis [15][16][17]. Likewise, a correlation between smaller circular stapler diameter (25 cm) and higher stricture rate has been evidenced in a systematic review [18]. Recurrent nerve palsy is also more common after cervical esophagogastrostomy and confers an increased risk of aspiration [19].…”

Section: Pathophysiology and Symptomsmentioning

confidence: 99%

Functional syndromes and symptom-orientated aftercare after esophagectomy

Ukegjini

Vetter

Fehr

et al. 2021

Langenbecks Arch Surg

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Background Surgery is the cornerstone of esophageal cancer treatment but remains burdened with significant postoperative changes of gastrointestinal function and quality of life. Purpose The aim of this narrative review is to assess and summarize the current knowledge on postoperative functional syndromes and quality of life after esophagectomy for cancer, and to provide orientation for the reader in the challenging field of functional aftercare. Conclusions Post-esophagectomy syndromes include various conditions such as dysphagia, reflux, delayed gastric emptying, dumping syndrome, weight loss, and chronic diarrhea. Clinical pictures and individual expressions are highly variable and may be extremely distressing for those affected. Therefore, in addition to a mostly well-coordinated oncological follow-up, we strongly emphasize the need for regular monitoring of physical well-being and gastrointestinal function. The prerequisite for an effective functional aftercare covering the whole spectrum of postoperative syndromes is a comprehensive knowledge of the pathophysiological background. As functional conditions often require a complex diagnostic workup and long-term therapy, close interdisciplinary cooperation with radiologists, gastroenterologists, oncologists, and specialized nutritional counseling is imperative for successful management.

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The impact of circular stapler size on the risk of anastomotic stricture following total mesorectal excision in rectal cancer patients: A retrospective cross‐sectional study

Behboudi,

Ahmadi‐Tafti,

Hosseini

et al. 2023

Health Science Reports

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IntroductionColorectal cancer (CRC) surgery complications are a major issue affecting morbidity and mortality rates. Anastomotic stricture, which occurs in almost 30% of patients after surgery for rectal cancer, is one of the most serious but underreported side effects. In this study, we tried to assess the effect of stapler size on anastomotic stricture rate.Materials and MethodsAt our facility, all patients underwent low anterior resections (LAR) performed using an open laparotomy technique. A contour‐curved stapler and an end‐to‐end anastomosis (EEA) circular stapler were used in the double stapling technique (DST). All patients also underwent a protective loop ileostomy. Patients who developed stricture following leakage were excluded.ResultsThis study comprised a total of 173 rectal cancer patients. A 29‐mm circle stapler was used to anastomose 77 patients (44.5%), while a 31‐mm circular stapler was used to anastomose 96 patients (55.5%). Six individuals experienced strictures; two had a 29 mm stamper and four (4.4%) had a 31 mm one. There was no significant difference between the two groups (p:0.575). On aggregate, 8 patients experienced leakage; 3 (3.8%) of these patients received treatment with a 29 mm stapler, whereas 5 (5.2%) received treatment with a 31 mm stapler.Conclusionthis study found no statistically significant difference in the stricture rates and stapler size. The findings of this study provide credibility to the notion that in rectal cancer patients having LAR, strictures can be safely avoided by performing the anastomoses with both staplers.

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Association Between Circular Stapler Diameter and Stricture Rates Following Gastrointestinal Anastomosis: Systematic Review and Meta-analysis

Abstract: The use of larger circular stapler sizes is strongly associated with reduced risk of anastomotic stricture in the upper GI tract, though data from lower GI joins are limited.

Cited by 20 publications

References 67 publications

The Circular Stapled Esophagogastric Anastomosis in Esophagectomy: No Differences in Anastomotic Insufficiency and Stricture Rates Between the 25 mm and 28 mm Circular Stapler

The Circular Stapled Esophagogastric Anastomosis in Esophagectomy: No Differences in Anastomotic Insufficiency and Stricture Rates Between the 25 mm and 28 mm Circular Stapler

Functional syndromes and symptom-orientated aftercare after esophagectomy

The impact of circular stapler size on the risk of anastomotic stricture following total mesorectal excision in rectal cancer patients: A retrospective cross‐sectional study

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