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Published on: March 24, 2023
Current evidence on powered versus manual circular staplers in colorectal surgery: a systematic review and
José Martín-Arévalo1,2, David Moro-Valdezate3,4, Leticia Pérez-Santiago3
1Colorectal Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain. jose.arevalo@uv.es.
Purpose:
This meta-analysis aims to evaluate the efficacy of powered circular staplers (PCS) compared to manual circular staplers (MCS) in reducing anastomotic leakage (AL) and postoperative bleeding (AB) in colorectal surgery.
Methods:
Extensive searches were performed in the Embase, PubMed, and SCOPUS electronic bibliographic databases. Most studies were of an observational nature, and only one randomized clinical trial was identified.
Results:
Twelve studies met the inclusion criteria for anastomotic leakage and five for anastomotic hemorrhage. The number of patients included for AL analysis was 4524. The leakage rate was 4.6% (208 cases). The number of patients with AB was 2868 with a bleeding rate of 4.99% (143 patients). After identifying outliers and studies with possible selection bias, the odds ratio (OR) for leaks and PCS was 0.38 (95% CI 0.26-0.55), the relative risk was - 0.05 (95% CI - 0.07 to 0.03), and the number needed to treat to prevent one leak was 20. For bleeding, the PCS OR for PCS was 0.20 (95% CI 0.0772-0.5177).
Conclusion:
Powered circular staplers could be associated with a significantly lower risk of leakage and anastomotic bleeding than two-row manual circular staplers. Further prospective randomized trials are needed to validate these findings.
