| Objective:By analyzing the effect of circular stapler or linear cutting closure device on anastomotic complications under laparoscopic total gastrectomy for esophagojejunal reconstruction,it provides more reliable evidence for the choice of two staplers.Methods:The literatures before December 2021 were retrieved.Keywords included: total gastrectomy,gastrectomy,circular,linear or linear,stapler,gastrectomy,circular or linear stapler.Refer to relevant literature search strategies to formulate a search strategy.Search in Chinese and foreign literature databases such as Pub Med,CNKI and Wanfang Database.Meta-analysis was performed using STATA 12.0,and the data were presented as forest plots.A funnel plot was drawn combined with Egger’s test to evaluate publication bias,and sensitivity analysis was used to evaluate the robustness of the results.Results:1.The basic information of the included literature,a total of 21 literatures were included,all of them performed laparoscopic total gastrectomy,and esophagojejunal anastomosis using linear or circular staplers,11 of which clearly pointed out that a certain number of cases would be performed by a certain number of surgical experience or laparoscopic surgery.Qualified surgeons performed the procedure,5articles clearly indicated the use of the Roun-en-Y reconstruction modality and defined anastomotic complications.A total of 16 literatures provided data on the operation time,with a total of 2509 patients;a total of 15 literatures were included in the intraoperative blood loss,a total of 1963 patients;a total of 10 literatures were included in the analysis of the postoperative first exhaust time,a total of 2036 patients;hospitalization time A total of 12 articles were included,with a total of 2507 patients;a total of 20 anastomotic-related complications.A total of 3352 patients were included;20 studies were included for anastomotic leakage,a total of 3352 patients;18 studies were included for anastomotic stenosis,a total of 2092 patients;15 studies were included for anastomotic bleeding.A total of 2629 patients.2.Meta-analysis results of two types of anastomotic devices for reconstruction of esophagojejunostomy.The results showed that the use of linear cutting closure device and circular stapler for esophagojejunal reconstruction was significantly improved in operation time(WMD=11.65,95%CI=[-10.90,34.2],P=0.31),intraoperative blood loss(WMD=2.72,95 %CI=[-28.52,33.96],P=0.87),length of hospital stay(WMD=0.23,95%CI=[-1.28,1.74],P=0.77)and time to first exhaust after operation(WMD=-0.21,95%CI=[-0.55,0.13],P=0.23),there was no significant difference.In terms of anastomotic-related complications,the linear stapler was better than the circular stapler(OR=0.43,95%CI=[0.33,0.57],P<0.0001),and the difference was statistically significant.However,further analysis showed that only in terms of anastomotic stenosis(OR=0.27,95%CI=[0.16,0.43],P<0.0001),the linear cutting closure was better than the circular one.In terms of anastomotic leakage(OR=0.74,95%CI=[0.52,1.05],P=0.09)and anastomotic bleeding(OR=0.68,95%CI=[0.33,1.39],P=0.29)The difference was not statistically significant.Conclusion:Laparoscopic total gastrectomy with esophagojejunostomy has a lower incidence of anastomotic stenosis with linear stapler than with circular stapler,in terms of operation time,intraoperative blood loss,hospital stay,postoperative exhaust time,anastomotic leakage and anastomotic bleeding No significant difference was found. |
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