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

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.