| Objective:To evaluate the safety and curative effect of linear stapler in laparoscopic total gastrectomy.Methods:To retrieve the PubMed,Springer,Cochrane Library,Embase,CNKI and Wanfang database,The literatures were RCT or RNT from January 2008 to January2018,included compared linear stapler versus circular stapler applied in laparoscopic total gastrectomy.The literature data were analyzed by Cochrane Cooperative Network provided RevMan 5.3 software meta-analysis.Results:According to the inclusion and exclusion criteria,a total of 12 RNT studies were included.A total of 1793 patients were included in the study,including linear stapler group 1101 cases and circular stapler group 692 cases.linear versus circular stapler in laparoscopic total gastrectomy meta-analysis showed that:shorter first exhaust time after operation(SMD=-0.26,95% CI-0.38~-0.14,P<0.0001),earlier first feeding time(SMD=-0.50,95% CI-0.93~0.07,P=0.02),lower incidence of anastomotic leakage(OR=0.53,95% CI 0.33 ~ 0.85,P=0.008)and anastomotic stricture(OR=0.45,95% CI 0.22~0.95,P=0.04);The time of operation(SMD=0.45,95% CI-0.16~1.06,P=0.15),the reconstruction time of digestive tract(SMD=0.34,95% CI-0.97~0.00,P=0.61),intraoperative bleeding volume(SMD=-0.39,95% CI-0.34~1.11,P=0.30),the number of lymph node dissection(SMD=-0.28,95% CI-0.92~0.36,P=0.40),the distance from the proximal margin of the tumor SMD=-0.08,95%CI-0.92~0.36,P=0.74),the postoperative hospitalization days(SMD=-0.10,95% CI-0.39~-0.60,P=0.68),and the total postoperative complications(OR=0.81,95% CI0.63 ~ 1.04,P=0.09),anastomotic haemorrhage(OR=0.59,95% CI 0.13 ~2.70,P=0.50),P > 0.05,none of the results were statistically significant.Conclusion:Linear stapler is also safe and feasible in laparoscopic total gastrectomy.It can reduce the incidence of anastomotic fistula and stenosis,without increase total postoperative complications. |
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