Efficacy and Safety of Nickel-titanium Shape Memoryalloy Compression Anastomosis Clip for Gastrointestinal Anastomosis: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WUHong-zi ¹ , SHIPing-ping ¹ ,  WANGJian-min ²

1. First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China;
2. Department of Surgery, First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

WANGJian-min, Email: lyw6743@sina.com

Keywords：

Pressure anastomosis clip; Surgical stapling; Anastomosis; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20140157

Video：

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Objective To systematically review the efficacy and safety of nickel-titanium shape memory alloy compression anastomosis clip (Ni-Ti CAC) for gastrointestinal anastomosis. Methods The Cochrane Library, PubMed, Web of Knowledge and CBM databases were searched for the randomized controlled trials (RCTs) that investigated the efficacy and safety of Ni-Ti CAC versus surgical stapler for gastrointestinal anastomosis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2. Results Eight RCTs involving 457 patients were included in the meta-analysis. The results of meta-analysis showed that, compared with the surgical stapler group, the Ni-Ti CAC group was superior in operation time (MD=-8.30, 95%CI-15.58 to-1.02, P=0.03), food intake (MD=-0.37, 95%CI-0.70 to-0.03, P=0.03), bowel movement (MD=-1.13, 95%CI-1.67 to-0.59, P < 0.000 1), passing gas time (MD=-0.30, 95%CI-0.55 to-0.06, P=0.01), and length of hospital stay (MD=-1.04, 95%CI-1.35 to-0.74, P < 0.000 01), with significant differences. No significant difference was found in anastomosis time (MD=-1.84, 95%CI-3.91 to 0.22, P=0.08). As for safety, no significant difference was found in anastomosis-related complications between both groups. Conclusion Current evidence shows that Ni-Ti CAC achieves better efficacy and safety in gastrointestinal anastomosis compared with surgical stapler.

Citation： WUHong-zi, SHIPing-ping, WANGJian-min. Efficacy and Safety of Nickel-titanium Shape Memoryalloy Compression Anastomosis Clip for Gastrointestinal Anastomosis: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 942-949. doi: 10.7507/1672-2531.20140157 Copy

1.	Natale C, Ferrozzi L, Pellegrino C, et al. Digestive anastomosis in general surgery. G Chir, 1998, 19(4): 175-183.
2.	Robicsek F. The birth of the surgical stapler. Surg Gynecol Obstet, 1980, 150(4): 579-583.
3.	Gambee LP, Garnjobst W, Hardwick CE. Ten years' experience with a single layer anastomosis in colon surgery. Am J Surg, 1956, 92(2): 222-227.
4.	Hardy TG Jr, Pace WG, Maney JW, et al. A biofragmentable ring for sutureless bowel anastomosis. An experimental study. Dis Colon Rectum, 1985, 28(7): 484-490.
5.	Qing LL, Fu MH, Pan D. Application of nickel titanium compression anastomosis clip in gastrointestinal anastomosis. Chin J Dig Surg, 2013, 12: 504-507.
6.	Fuko NF, Rubin FF, Lelcuk RF, et al. A memory-shape temperature-dependent nickel-titanium device for colonic anastomosis in laparoscopic surgery. Minim Invasive Ther Allied Technol, 2004, 13(1): 36-41.
7.	Kim HR, Lee WY, Jung KU, et al. Early surgical outcomes of NiTi endoluminal compression anastomotic clip (NiTi CAC 30) use in patients with gastrointestinal malignancy. J Laparoendosc Adv Surg Tech A, 2012, 22(5): 472-478.
8.	Nudelman I, Fuko V, Rubin M, et al. A nickel-titanium memory-shape device for colonic anastomosis in laparoscopic surgery. Surgical Endoscopy, 2004, 18(7): 1085-1089.
9.	Nudelman IL, Fuko V, Greif F, et al. Colonic anastomosis with the nickel-titanium temperature-dependent memory-shape device. Am J Surg, 2002, 183(6): 697-701.
10.	Tucker ON, Beglaibter N, Rosenthal RJ. Compression anastomosis for Roux-en-Y gastric bypass: observations in a large animal model. Surg Obes Relat Dis, 2008, 4(2): 115-121.
11.	江志伟, 李宁, 黎介寿, 等.应用镍钛记忆合金加压吻合夹进行小肠吻合的临床研究.中华外科胃肠杂志, 2006, 9(5): 392-394.
12.	Nudelman I, Fuko V, Waserberg N, et al. Colonic anastomosis performed with a memory-shaped device. Am J Surg, 2005, 190(3): 434-438.
13.	Liu PC, Jiang ZW, Zhu XL, et al. Compression anastomosis clip for gastrointestinal anastomosis. World J Gastroenterol, 2008, 14(31): 4938-4942.
14.	李心翔, 蔡三军, 髙瑾, 等.镍钛记忆合金加压吻合环应用于结直肠术后肠道重建的前瞻性研究.中华胃肠外科杂志, 2011, 14(5): 330-332.
15.	蔡绍环, 徐志峰, 杨永锐, 等.镍钛记忆合金加压吻合夹在全胃切除术中的应用.医学综述, 201319(2): 379-380.
16.	魏晟宏, 陈路川, 余晖.镍钛记忆合金加压吻合夹在胃癌术后消化道重建中应用的临床观察.福建医药杂志, 2012, 34(4): 33-34.
17.	王剑平, 徐志峰, 王明元, 等.镍钛记忆合金加压吻合夹在胃肠吻合中的应用.世界华人杂志, 2008, 16(16): 1812-1814.
18.	华颂文, 熊力, 文宇, 等.应用镍钛记忆合金加压吻合夹行胃肠吻合的安全性与有效性分析.中南大学学报(医学版), 2011, 36(4): 351-354.
19.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2010, Available at: www.cochrane-handbook.org.
20.	Song C, Frank T, Cuschieri A. Shape memory alloy clip for compression colonic anastomosis. J Biomech Eng, 2005, 127(2): 351-354.
21.	Aggarwal R, Darzi A. Compression anastomoses revisited. J Am Coll Surg, 2005, 201(6): 965-971.
22.	Wullstein C, Gross E. Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients. Br J Surg, 2000, 87(8): 1071-1075.
23.	McGuire J, Wright IC, Levermont JN, et al. Surgical staplers: a review. J R Coll Surg Edinb, 1997, 42(1): 1-9.
24.	Dietz UA, Debus ES, Hirt AL, et al. From Murphy's button to the Valtrac Ring. 100 years in search of a paradigm. Zentralbl Chir, 1999, 124(7): 653-656.
25.	Corman ML, Prager ED, Hardy TG, et al. Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial. Dis Colon Rectum, 1989, 32(3): 183-187.
26.	Nudelman IL, Fuko VV, Morgenstern S, et al. Gastrointestinal anastomosis with the nickel-titanium double ring. World J Surg, 2000, 24(7): 874-877.
27.	Scott AD, Uff C, Phillips RK. Suppression of macrophage function by suture materials and anastomotic recurrence of Crohn's disease. Br J Surg, 1993, 80(3): 387-391.
28.	Sou S, Matsui T, Yao T, et al. Differentiating enterocutaneous fistulae from suture abscesses complicating Crohn's disease using oral administration of indocyanine green. J Gastroenterol Hepatol, 2006, 21(12): 1850-1853.
29.	Scarpa M, Angriman I, Barollo M, et al. Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease. Hepatogastroenterology, 2004, 51(58): 1053-1057.

1. Natale C, Ferrozzi L, Pellegrino C, et al. Digestive anastomosis in general surgery. G Chir, 1998, 19(4): 175-183.
2. Robicsek F. The birth of the surgical stapler. Surg Gynecol Obstet, 1980, 150(4): 579-583.
3. Gambee LP, Garnjobst W, Hardwick CE. Ten years' experience with a single layer anastomosis in colon surgery. Am J Surg, 1956, 92(2): 222-227.
4. Hardy TG Jr, Pace WG, Maney JW, et al. A biofragmentable ring for sutureless bowel anastomosis. An experimental study. Dis Colon Rectum, 1985, 28(7): 484-490.
5. Qing LL, Fu MH, Pan D. Application of nickel titanium compression anastomosis clip in gastrointestinal anastomosis. Chin J Dig Surg, 2013, 12: 504-507.
6. Fuko NF, Rubin FF, Lelcuk RF, et al. A memory-shape temperature-dependent nickel-titanium device for colonic anastomosis in laparoscopic surgery. Minim Invasive Ther Allied Technol, 2004, 13(1): 36-41.
7. Kim HR, Lee WY, Jung KU, et al. Early surgical outcomes of NiTi endoluminal compression anastomotic clip (NiTi CAC 30) use in patients with gastrointestinal malignancy. J Laparoendosc Adv Surg Tech A, 2012, 22(5): 472-478.
8. Nudelman I, Fuko V, Rubin M, et al. A nickel-titanium memory-shape device for colonic anastomosis in laparoscopic surgery. Surgical Endoscopy, 2004, 18(7): 1085-1089.
9. Nudelman IL, Fuko V, Greif F, et al. Colonic anastomosis with the nickel-titanium temperature-dependent memory-shape device. Am J Surg, 2002, 183(6): 697-701.
10. Tucker ON, Beglaibter N, Rosenthal RJ. Compression anastomosis for Roux-en-Y gastric bypass: observations in a large animal model. Surg Obes Relat Dis, 2008, 4(2): 115-121.
11. 江志伟, 李宁, 黎介寿, 等.应用镍钛记忆合金加压吻合夹进行小肠吻合的临床研究.中华外科胃肠杂志, 2006, 9(5): 392-394.
12. Nudelman I, Fuko V, Waserberg N, et al. Colonic anastomosis performed with a memory-shaped device. Am J Surg, 2005, 190(3): 434-438.
13. Liu PC, Jiang ZW, Zhu XL, et al. Compression anastomosis clip for gastrointestinal anastomosis. World J Gastroenterol, 2008, 14(31): 4938-4942.
14. 李心翔, 蔡三军, 髙瑾, 等.镍钛记忆合金加压吻合环应用于结直肠术后肠道重建的前瞻性研究.中华胃肠外科杂志, 2011, 14(5): 330-332.
15. 蔡绍环, 徐志峰, 杨永锐, 等.镍钛记忆合金加压吻合夹在全胃切除术中的应用.医学综述, 201319(2): 379-380.
16. 魏晟宏, 陈路川, 余晖.镍钛记忆合金加压吻合夹在胃癌术后消化道重建中应用的临床观察.福建医药杂志, 2012, 34(4): 33-34.
17. 王剑平, 徐志峰, 王明元, 等.镍钛记忆合金加压吻合夹在胃肠吻合中的应用.世界华人杂志, 2008, 16(16): 1812-1814.
18. 华颂文, 熊力, 文宇, 等.应用镍钛记忆合金加压吻合夹行胃肠吻合的安全性与有效性分析.中南大学学报(医学版), 2011, 36(4): 351-354.
19. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2010, Available at: www.cochrane-handbook.org.
20. Song C, Frank T, Cuschieri A. Shape memory alloy clip for compression colonic anastomosis. J Biomech Eng, 2005, 127(2): 351-354.
21. Aggarwal R, Darzi A. Compression anastomoses revisited. J Am Coll Surg, 2005, 201(6): 965-971.
22. Wullstein C, Gross E. Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients. Br J Surg, 2000, 87(8): 1071-1075.
23. McGuire J, Wright IC, Levermont JN, et al. Surgical staplers: a review. J R Coll Surg Edinb, 1997, 42(1): 1-9.
24. Dietz UA, Debus ES, Hirt AL, et al. From Murphy's button to the Valtrac Ring. 100 years in search of a paradigm. Zentralbl Chir, 1999, 124(7): 653-656.
25. Corman ML, Prager ED, Hardy TG, et al. Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial. Dis Colon Rectum, 1989, 32(3): 183-187.
26. Nudelman IL, Fuko VV, Morgenstern S, et al. Gastrointestinal anastomosis with the nickel-titanium double ring. World J Surg, 2000, 24(7): 874-877.
27. Scott AD, Uff C, Phillips RK. Suppression of macrophage function by suture materials and anastomotic recurrence of Crohn's disease. Br J Surg, 1993, 80(3): 387-391.
28. Sou S, Matsui T, Yao T, et al. Differentiating enterocutaneous fistulae from suture abscesses complicating Crohn's disease using oral administration of indocyanine green. J Gastroenterol Hepatol, 2006, 21(12): 1850-1853.
29. Scarpa M, Angriman I, Barollo M, et al. Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease. Hepatogastroenterology, 2004, 51(58): 1053-1057.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Nickel-titanium Shape Memoryalloy Compression Anastomosis Clip for Gastrointestinal Anastomosis: A Meta-Analysis

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