# Stapled vs. hand-sewn anastomosis during esophagectomy: a randomized trials systematic review and meta-analysis

## TL;DR

This study compares stapled and hand-sewn anastomosis techniques during esophagectomy and finds no significant differences in complication rates, though stapled methods may save time.

## Contribution

A systematic review and meta-analysis comparing stapled and hand-sewn anastomosis techniques in esophagectomy for short-term outcomes.

## Key findings

- Stapled and hand-sewn anastomosis show similar rates of leaks and strictures.
- Stapled anastomosis is associated with shorter operative times.
- No significant differences in postoperative complications or mortality between the two techniques.

## Abstract

Esophagogastric anastomosis during esophagectomy is a technically demanding step, carrying a high complication rate. Numerous techniques for anastomosis fashioning have been described, including hand-sewn (HS) and stapled (ST) anastomosis however, the optimal method remains uncertain.

Analyse short-term outcomes for ST vs. HS anastomosis.

Systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. Primary outcomes were anastomotic leak (AL) and stricture (AS).

Twelve RCTs (2015 patients) were included. All trials were deemed to have an intermediate risk of bias. ST anastomosis was performed in 51.9%. The age of the patient population ranged from 37 to 88 years and 73% were males. Squamous cell carcinoma was diagnosed in 76.9% of patients. Neoadjuvant therapy was completed in 32.9%. Ivor-Lewis or McKeown esophagectomy were performed with thoracic (57.2%) or cervical (42.8%) anastomosis. No significant differences were found for ST vs. HS anastomosis for AL (RR 0.97; 95% CI 0.70–1.35) and AS (RR 1.47; 95% CI 0.96–2.23). Further, no differences were found for cardiovascular complications (RR 1.09; p = 0.59), pulmonary complication (RR 1.12; p = 0.28), length of stay (SMD 0.03; p = 0.69), and 30-day mortality (RR 1.30; p = 0.18). Operative time was shorter in ST anastomosis (SMD − 0.11; p = 0.002).

ST and HS esophagogastric anastomosis yield comparable rates of AL, AS, postoperative complications, and in-hospital mortality. The use of ST anastomosis may result in a shorter operative time. The choice of technique should be determined by the surgeon’s expertise and clinical scenario.

The online version contains supplementary material available at 10.1007/s13304-025-02464-y.