Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis

Abstract

Background

Anastomotic devices, including linear staplers (LSs) and circular staplers (CSs), have been widely used after laparoscopic gastric surgery. However, it is controversial whether linear stapling is superior to circular stapling for anastomosis. Thus, we conducted a meta-analysis to compare the aspects of postoperative complications, particularly anastomotic stricture and anastomotic leakage, on the use of the two techniques to assist clinical decision-making.

Methods

We conducted a systematic search using Embase, PubMed, and Cochrane Library to evaluate studies that compared LSs and CSs after laparoscopic gastric surgery.

Results

Pooled analysis suggested that patients who received LSs had fewer postoperative complications (P = 0.019), and anastomotic complications (P < 0.001), stricture (P = 0.001), and bleeding (P = 0.005). The subgroup analyses showed that LSs caused fewer anastomotic complications (P < 0.001), anastomotic strictures (P < 0.001), and postoperative hemorrhage (P = 0.007) in patients with gastric cancer than CS. In addition, LSs caused fewer incidences of overall morbidity (P = 0.042), anastomotic strictures (P = 0.023), postoperative hemorrhage (P < 0.001), wound infection (P < 0.001), and shorter length of hospital stay (P = 0.048) in patients with obesity. Furthermore, the subgroup analyses showed that the use of LS resulted in lower overall morbidity (P = 0.042), anastomotic stricture (P = 0.023), wound infection (P < 0.001), length of hospital stay (P = 0.048), and postoperative hemorrhage (P < 0.001) when applied in gastrojejunostomy, while LSs resulted in fewer anastomotic complications (P < 0.001), anastomotic stricture (P = 0.016) than CS when applied in esophagojejunostomy.

Conclusion

Compared with CSs, LSs yielded a lower incidence of overall morbidity, anastomotic complications, anastomotic stricture, bleeding, and wound infection, indicating that linear stapling is safer and more efficient than circular stapling when performing anastomosis after laparoscopic gastric surgery.

Keywords:

• linear stapler
• circular stapler
• anastomosis
• laparoscopic gastrectomy
• reconstruction

Author contributions

Tao Jin and Han-Dong Liu had the same contribution to this paper. Study conception and design: Tao Jin, Kun Yang. Acquisition of data: Tao Jin, Han-Dong Liu, Ze-Hua Chen, Kun Yang. Analysis and interpretation of data: Tao Jin, Ze-Hua Chen, Jian-Kun Hu, Kun Yang. Drafting of the manuscript: Tao Jin, Han-Dong Liu, Kun Yang. Critical revision: Tao Jin, Han-Dong Liu, Kun Yang. Approval of the final manuscript: all authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Statement of ethics

All analyses were based on previously published studies, thus, no ethical approval and patient consent is required.

Data statement

Some or all data, models, or code generated or used during the study are available from the corresponding author by request.

Additional information

Funding

Domestic support was received from the (1) National Natural Science Foundation of China (No. 81772547); (2) Fundamental Research Funds for the Central Universities (No. 2017SCU04A18); (3) Young Scientific and Academic Leaders Training Program of Sichuan University (No. 0082604151001/035); (4) Foundation of Science & Technology Department of Sichuan Province (No. 2019YFS0256); and (5) 1. 3. 5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZY2017304).