2.
Nesta revisão sistemática e meta-análise conduzida por investigadores da Universidade do Minho, foram comparadas as diferentes técnicas de abordagem cirúrgica na confecção de anastomoses colo-rectais (sutura manual, sutura mecânica, ou sutura compressiva) relativamente à ocorrência de complicações pós-operatórias.
Trata-se de uma meta-análise que integra 16 estudos, e que aponta diferenças estatisticamente significativas, mediante técnica usada, no tempo de Cirurgia e na necessidade de reintervenção.
Contudo, os autores concluem que os resultados obtidos não são suficientes para demonstrar qual a técnica mais adequada para realizar a anastomose cólica e rectal, uma vez que as complicações pós-operatórias foram semelhantes entre as técnicas de sutura manual, anastomose mecânica, ou de compressão, pelo que se mantém espaço para estudo sobre o tema das anastomoses colo-rectais no que concerne à técnica de confecção.
Oliveira A, Faria S, Gonçalves N, Martins A, Leão P. Surgical approaches to colonic and rectal anastomosis: systematic review and meta-analysis. Int J Colorectal Dis. 2023 Feb 23;38(1):52. doi: 10.1007/s00384-023-04328-6. PMID: 36814011; PMCID: PMC9947093.
Abstract
Purpose Postoperative complications after a colonic and rectal surgery are of significant concern to the surgical community. Although there are different techniques to perform anastomosis (i.e., handsewn, stapled, or compression), there is still no consensus on which technique provides the least number of postoperative problems. The objective of this study is to compare the different anastomotic techniques regarding the occurrence or duration of postoperative outcomes such as anastomotic dehiscence, mortality, reoperation, bleeding and stricture (as primary outcomes), and wound infection, intra-abdominal abscess, duration of surgery, and hospital stay (as secondary outcomes).
Methods Clinical trials published between January 1, 2010, and December 31, 2021, reporting anastomotic complications with any of the anastomotic technique were identified using the MEDLINE database. Only articles that clearly defined the anastomotic technique used, and report at least two of the outcomes defined were included.
Results This meta-analysis included 16 studies whose differences were related to the need of reoperation (p<0.01) and the duration of surgery (p=0.02), while for the anastomotic dehiscence, mortality, bleeding, stricture, wound infection, intraabdominal abscess, and hospital stay, no significant differences were found. Compression anastomosis reported the lowest reoperation rate (3.64%) and the handsewn anastomosis the highest (9.49%). Despite this, more time to perform the surgery was required in compression anastomosis (183.47 min), with the handsewn being the fastest technique (139.92 min).
Conclusions The evidence found was not sufficient to demonstrate which technique is most suitable to perform colonic and rectal anastomosis, since the postoperative complications were similar between the handsewn, stapled, or compression techniques.
Keywords Anastomosis · Colon · Rectum · Handsewn · Stapled · Compression