Risk of anastomotic leakage with two-row versus three-row manual circular staplers in colorectal anastomosis: a U.S. cohort study

Wang, Tongtong; Sadowsky, Mordechai; Blakney, Rebekah; Coplan, Paul; Petraiuolo, William; Soberman, Mark; Tomaszewski, Joerg; Rene, Lexi; Wood, Jennifer

doi:10.1007/s00384-023-04552-0

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…Furthermore, there is some heterogeneity in the studies because multicentre studies have been included, some of them with cases from large national databases or on-going clinical trials not designed to assess the difference in leakage rates among different devices [ 29 , 39 , 40 ]. At this point, it may be premature to state that MCS devices have worse outcomes than the newer PCS or TRCS devices primarily because there is no clear evidence in this regard [ 22 , 24 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sensitivity analysis did not detect significant problems in the PCS meta-analysis. However, in the case of TRCS, the work presented by Wang et al [ 30 ] was the one that introduced the greatest heterogeneity to the analysis, probably because sample size and the values recorded for leakage differed from those provided by the other three studies [ 12 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of the pathology motivating surgical intervention in this meta-analysis included benign and malignant pathology in three studies [ 17 , 24 , 37 ] in the PCS meta-analysis, similar to that of the TRCS meta-analysis [ 12 , 29 , 30 ]. However, subgroups analysis, according to pathology, did not seem to have an influence on the results and confirmed the validity and robustness of both meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

“…One of the limitations of this meta-analysis is the small number of studies available and the absence of randomised clinical trials. All the studies included in the meta-analyses, except Quero et al and Want et al studies [ 30 , 38 ], have included propensity score matching, with the inherent limitations of this statistical method. The validity and reality of results of two of the included studies [ 37 , 39 ] has been questioned by other authors who appreciated possible caveats in the propensity score matching [ 29 ], although they did not question the results of other studies with similar characteristics [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The results reported in studies on the reduction of anastomotic complications of two-row manual circular staplers (MCS) and PCS or TRCS [ 11 , 12 , 17 – 30 ] are controversial, with low evidence of the superiority of PCS or TRCS over traditional two-row manual circular staplers.…”

Section: Introductionmentioning

confidence: 99%

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Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis

Martín-Arévalo,

Pla-Martí,

Huntley

et al. 2024

Int J Colorectal Dis

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Purpose Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these circular staplers would have a lower risk of presenting a leak (AL) and/or anastomotic bleeding (AB). Methods An in-depth search was carried out in the electronic bibliographic databases Embase, PubMed and SCOPUS. Observational studies were included, since randomized clinical trials comparing circular staplers were not found. Results In the case of AL, seven studies met the inclusion criteria in the PCS group and four in the TRCS group. In the case of AB, only four studies could be included in the analysis in the PCS group. The AL OR reported for PCS was 0.402 (95%-confidence interval (95%-CI): 0.266–0.608) and for AB: 0.2 (95% CI: 0.08–0.52). The OR obtained for AL in TRCS was 0.446 (95%-CI: 0.217 to 0.916). Risk difference for AL in PCS was − 0.06 (95% CI: − 0.07 to − 0.04) and in TRCS was − 0.04 (95%-CI: − 0.08 to − 0.01). Subgroup analysis did not report significant differences between groups. On the other hand, the AB OR obtained for PCS was 0.2 (95% CI: 0.08–0.52). In this case, no significant differences were observed in subgroup analysis. Conclusion PCS presented a significantly lower risk of leakage and anastomotic bleeding while TRCS only demonstrated a risk reduction in AL. Risk difference of AL was superior in the PCS than in TRCS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis

Martín-Arévalo,

Pla-Martí,

Huntley

et al. 2024

Int J Colorectal Dis

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Does Tri‐Staple™ technology reduce the risk of anastomotic leakage in colorectal surgery? A propensity score matching analysis

Gerbasi,

Tustumi,

Seid

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesThis study evaluates the Tri‐Staple™ technology in colorectal anastomosis.MethodsPatients who underwent rectosigmoidectomy between 2016 and 2022 were retrospectively evaluated and divided into two groups: EEA™ (EEA) or Tri‐Staple™ (Tri‐EEA). The groups were matched for age, sex, American Society of Anesthesiologists (ASA), and neoadjuvant radiotherapy using propensity score matching (PSM).ResultThree hundred and thirty‐six patients were included (228 EEA; 108 Tri‐EEA). The groups were similar in sex, age, and neoadjuvant therapy. The Tri‐EEA group had fewer patients with ASA III/IV scores (7% vs. 33%; p < 0.001). The Tri‐EEA group had a lower incidence of leakage (4% vs. 11%; p = 0.023), reoperations (4% vs. 12%; p = 0.016), and severe complications (6% vs. 14%; p = 0.026). There was no difference in complications, mortality, readmission, and length of stay. After PSM, 108 patients in the EEA group were compared with 108 in the Tri‐EEA group. The covariates sex, age, neoadjuvant radiotherapy, and ASA were balanced, and the risk of leakage (4% vs. 12%; p = 0.04), reoperation (4% vs. 14%; p = 0.014), and severe complications (6% vs. 15%; p = 0.041) remained lower in the Tri‐EEA group.ConclusionTri‐Staple™ reduces the risk of leakage in colorectal anastomosis. However, this study provides only insights, and further research is warranted to confirm these findings.

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Effect of powered circular stapler in colorectal anastomosis after left-sided colic resection: systematic review and meta-analysis

Scardino,

Riva,

Sorrentino

et al. 2024

Int J Colorectal Dis

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Purpose Anastomotic leak (AL) remains the most important complication after left-sided colic anastomoses and technical complications during anastomotic construction are responsible of higher leakage incidence. Powered circular stapler (PCS) in colorectal surgery has been introduced in order to reduce technical errors and post-operative complications due to the manual circular stapler (MCS). Methods A systematic review and meta-analysis were performed. An electronic systematic search was performed using Web of Science, PubMed, and Embase of studies comparing PCS and MCS. The incidence of AL, anastomotic bleeding (AB), conversion, and reoperation were assessed. PROSPERO Registration Number: CRD42024512644. Results Five observational studies were eligible for inclusion reporting on 2379 patients. The estimated pooled Risk Ratios for AL and AB rates following PCS were significantly lower than those observed with MCS (0.44 and 0.23, respectively; both with p < 0.01). Conversion and reoperation rate did not show any significant difference: 0.41 (95% CI 0.09–1.88; p = 0.25) and 0.78 (95% CI 0.33–1.84; p = 0.57); respectively. Conclusion The use of PCS demonstrates a lower incidence of AL and AB compared to MCS but does not exhibit a discernible influence on reintervention or conversion rates. The call for future randomized clinical trials aims to definitively clarify these issues and contribute to further advancements in refining surgical strategies for left-sided colonic resection.

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Risk of anastomotic leakage with two-row versus three-row manual circular staplers in colorectal anastomosis: a U.S. cohort study

Cited by 5 publications

References 29 publications

Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis

Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis

Does Tri‐Staple™ technology reduce the risk of anastomotic leakage in colorectal surgery? A propensity score matching analysis

Effect of powered circular stapler in colorectal anastomosis after left-sided colic resection: systematic review and meta-analysis

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