A Meta-analysis of Powered Circular Stapler Versus Manual Circular Stapler for Colorectal Anastomosis

The anastomotic leakage rate of the double stapling technique anastomosis in colorectal surgery remains high at approximately 10%. The Echelon Circular™ powered stapler (ECPS) has been recently reported to reduce the risk of anastomotic leakage. A meta-analysis was conducted to evaluate and compare the effectiveness of ECPS to that of the manual circular stapler (MCS) in left-sided colorectal resections.

We searched publicly available literature databases for studies published between 2018 and August 2024. The following search terms were used: "powered circular stapler", "powered circular", "anastomosis", and "powered echelon". We analyzed several outcomes including anastomotic leakage, major anastomotic leakage, and anastomotic bleeding. A subgroup analysis was performed to analyze Japanese cases only.

We identified 9 papers reporting results that compared ECPS for left-sided colorectal resection with MCS. Our meta-analysis included 3,301 patients with colorectal anastomosis; 1,135 had undergone ECPS and 2,166 had undergone MCS. The overall anastomotic leakage rate was significantly lower in the ECPS group than in the MCS group (p<0.0001). Regarding major anastomotic leakage, there was a tendency for the ECPS group to include fewer cases than the MCS group (p=0.10). For anastomotic bleeding, no significant difference was found between the two groups. In the subgroup analysis of Japanese patients, ECPS also showed significantly lesser anastomotic leakage than MCS.

ECPS may significantly reduce the rate of anastomotic leakage in left-sided colorectal surgery compared to MCS in both the Western and Asian populations.