Impact of powered circular stapling devices on anastomotic leakage rates in colorectal surgery

Anastomotic leakage (AL) remains a severe complication after colorectal surgery, increasing morbidity and mortality. Powered circular staplers may influence anastomotic healing through standardised compression and power distribution. This study aimed to compare clinical outcomes of powered versus manual circular staplers for transanal anastomoses.

This retrospective single-centre cohort study included consecutive patients undergoing colorectal resection with transanal circular anastomosis between January 2022 and June 2025. Primary endpoint was the incidence of AL according to stapler type. To ensure comparability between groups, propensity score matching was performed.

Among 333 patients, powered staplers were used in 69.1% and manual staplers in 30.9%. The overall AL rate was 15.0%. AL was significantly associated with higher BMI (28.1 vs. 26.6 kg/m²; p = .021), ASA ≥ 3 (64.0 vs. 46.0%; p = .019), diabetes mellitus (24.0 vs. 8.1%; p .001), open (34.0 vs. 19.1%) or converted surgeries (14.0 vs. 4.9%; p = .004) and greater intraoperative fluid administration (2548.1 vs. 2188.8 ml; p = .015). Most patients (72.1%) followed enhanced recovery concepts (FAST TRACK) with trend toward lower adherence in the AL cohort (n.s.).  After propensity score matching, AL occurred in 9.7% following powered circular stapling and 11.8% following manual circular stapling (n.s.).

In this cohort, powered stapling devices were not associated with lower anastomotic leakage rates compared with manual staplers for transanal circular anastomosis in patients managed under modern minimally invasive and FAST TRACK concepts.