Meta‐analysis of handsewn versus stapled reversal of loop ileostomy

Background The morbidity associated with closure of loop ileostomy ( LI ) may be attributed to the various surgical techniques employed for the closure. The purpose of this review was to review the hand‐sutured ( HS ) versus the stapled anastomosis ( SA ) techniques, used in the reversal of LI . Methods The MEDLINE , P ub M ed, CINHAL , Cochrane library and Web of Knowledge databases were searched for randomized controlled trials ( RCTs ) and case‐control trials ( CCTs ), evaluating HS and SA in reversal of LI . Data extraction with risk of bias assessment was followed by subgroup and pooled data meta‐analysis where applicable per outcome. Results Four RCTs ( HS : 321, SA : 328) and 10 CCTs ( HS : 2808, SA : 1044) were identified, with a total of 4508 patients. Regardless of subgroup analysis, no difference was seen between the two techniques with regard to anastomotic leaks ( P = 0.24, odds ratio ( OR ): 1.37, 95% confidence interval ( CI ): 0.81–2.29) or re‐operation. The stapled group showed a significantly lower rate of conservatively managed small bowel obstruction ( SBO )/ ileus at 30 days ( P < 0.001, OR : 2.27, 95% CI : 1.59–2.96) ( P < 0.001) and SBO during combined short‐ and long‐term follow‐up ( P < 0.001). The SA also showed significant shorter operative time ( P = 0.02; WMD 11.52 min), time to first bowel opening ( P < 0.001; WMD 0.52 days) and length of hospital stay ( P = 0.03; WMD 0.70 days). Conclusion The stapled technique offers an advantage in terms of lower post‐operative subacute SBO rates, a faster operative technique and shorter hospitalization times. These perceived benefits make it potentially superior to HS for the reversal of LI .