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Related Experiment Video

Updated: Jan 7, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

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Published on: April 17, 2020

Three Versus Two-Rows Circular Stapler in Colorectal Anastomosis: Short Term Outcomes.

Stefano Agnesi¹, Marcello Schiavo¹, Andrea Balla²

¹Department of General Surgery, Policlinico di Monza, Monza, Italy.

Surgical Innovation

|December 26, 2025

Summary

Three-row circular staplers (CSs) significantly reduce anastomotic leakage (AL) after colorectal cancer surgery compared to two-row CSs. This innovation also leads to shorter hospital stays, improving patient outcomes and reducing healthcare costs.

Keywords:

colorectal surgery general surgery surgical oncology

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Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Published on: March 24, 2023

Area of Science:

Colorectal Surgery
Surgical Oncology
Gastrointestinal Surgery

Background:

Anastomotic leakage (AL) is a major complication following colorectal cancer surgery, impacting patient health and healthcare economics.
Conventional two-row circular staplers (CSs) may compromise anastomotic integrity and perfusion.
Three-row CSs offer potential for enhanced anastomotic integrity and perfusion.

Purpose of the Study:

To compare short-term outcomes of two-row versus three-row CSs in colorectal anastomosis.
To evaluate the impact of stapler type on anastomotic leakage (AL) rates.
To assess the effect of stapler type on hospital length of stay (LOS).

Main Methods:

Retrospective analysis of prospectively collected data from 2013-2025.
Inclusion of consecutive patients undergoing elective left hemicolectomy, sigmoidectomy, or anterior resection for cancer with primary anastomosis.
Comparison of AL rates and severity between patients receiving two-row CSs (control) and three-row CSs (intervention).

Main Results:

The three-row CS group showed a significantly lower AL rate (3.7%) compared to the two-row CS group (11.8%; P=0.02).
Patients in the three-row CS group experienced significantly shorter hospital stays (P=0.04).
Multivariate analysis identified two-row CS use as an independent adverse predictor of AL (OR 3.79; P=0.03).

Conclusions:

The use of three-row CSs is associated with a reduced postoperative AL rate.
Three-row CSs contribute to a shorter length of stay (LOS) post-surgery.
Three-row CSs represent an advancement in surgical technique for colorectal cancer resection, enhancing anastomotic safety.