Academic Journal
Hand-sewn versus stapled ileo-ileal anastomosis following radical cystectomy: A systematic review and meta-analysis.
| Τίτλος: | Hand-sewn versus stapled ileo-ileal anastomosis following radical cystectomy: A systematic review and meta-analysis. |
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| Συγγραφείς: | Abdelshafi A; Faculty of Medicine, Assiut University, Assiut, Egypt., Mohamed T; Urology Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK., Mohamed H; Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: Hamza.Ahmed00099@med.aun.edu.eg., Mohammed YA; Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt., Deamah MG; Urology Department, Prince Hamza Hospital, Amman, Jordan., Irshid BAB; Urology Department, Princess Basma Teaching Hospital, Irbid, Jordan., Ramez M; Urology Department, Eastern Virginia Medical School, Norfolk, VA; Urology Department, Mansoura University Urology and Nephrology Center, Mansoura, Egypt. |
| Πηγή: | Urologic oncology [Urol Oncol] 2026 Jul; Vol. 44 (7), pp. 215-224. Date of Electronic Publication: 2026 May 14. |
| Τύπος έκδοσης: | Journal Article; Systematic Review; Meta-Analysis; Comparative Study; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: United States NLM ID: 9805460 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2496 (Electronic) Linking ISSN: 10781439 NLM ISO Abbreviation: Urol Oncol Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2003- : Philadelphia, PA : Elsevier Original Publication: New York, NY : Elsevier Science |
| Ιατρικοί όροι (MeSH): | Cystectomy*/methods , Anastomosis, Surgical*/methods , Urinary Bladder Neoplasms*/surgery , Ileum*/surgery , Surgical Stapling*/methods , Suture Techniques*, Urinary Diversion/methods ; Humans ; Postoperative Complications |
| Περίληψη: | Radical cystectomy (RC) with urinary diversion is the standard treatment for muscle-invasive bladder cancer. Intestinal continuity may be restored using either hand-sewn or stapled ileo-ileal anastomosis, yet contemporary evidence comparing their clinical and economic outcomes is limited. This study aims to evaluate and compare perioperative outcomes, postoperative complications, and hospital parameters between these 2 techniques. PubMed, Scopus, Web of Science, and Cochrane Library were searched for studies published up to August 2025. Eligible studies compared stapled vs. hand-sewn ileo-ileal anastomosis following RC and reported at least 1 relevant perioperative or postoperative outcome. Data were extracted independently, and risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled analyses were performed using Review Manager software, with mean differences (MDs) and odds ratios (ORs) calculated under random- or fixed-effects models based on heterogeneity (I² statistic). Four studies encompassing 529 patients were included. There were no significant differences between techniques in estimated blood loss (MD = -17.39 [-61.26, 26.48]; P = 0.44), time to drain removal (MD = -1.00 [-2.24, 0.24]; P = 0.11), or gastrointestinal complications (OR = 1.13 [0.66, 1.93]; P = 0.66). Stapled anastomosis was associated with faster time to oral intake (MD = 0.31 [0.12, 0.50]; P = 0.001), whereas hand-sewn anastomosis demonstrated a modest advantage in time to flatus (MD = -0.25 [-0.49, -0.02]; P = 0.04). These differences were less than 1 day and of uncertain clinical relevance. Cost estimates reported in 2 contemporary robotic series suggested higher institutional costs for stapled techniques; however, these were not standardized across healthcare systems. Available retrospective evidence suggests broadly comparable safety profiles between hand-sewn and stapled ileo-ileal anastomoses following radical cystectomy. Observed differences in recovery metrics were statistically significant but small in magnitude and may not meaningfully alter postoperative recovery pathways. Given reported institutional cost differences, hand-sewn anastomosis may represent a resource-conscious alternative in selected settings. Prospective studies are needed to define clinically meaningful differences. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Hand-sewn anastomosis; Ileo-ileal anastomosis; Radical cystectomy; Stapled anastomosis; Urinary diversion |
| Entry Date(s): | Date Created: 20260514 Date Completed: 20260612 Latest Revision: 20260615 |
| Update Code: | 20260615 |
| DOI: | 10.1016/j.urolonc.2026.04.009 |
| PMID: | 42134079 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1873-2496 |
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| DOI: | 10.1016/j.urolonc.2026.04.009 |