Key result
Two-row manual circular staplers were associated with a similar risk of anastomotic leak within 30 days post-procedure compared to three-row devices in patients undergoing left-sided colorectal surgery (RR 0.72).
Why the study?
To compare the risk of anastomotic leak between two-row manual circular staplers and a three-row circular stapler with Tri-Staple technology in colorectal anastomosis.
Does the use of manual two-row circular staplers compared to three-row circular staplers reduce the risk of anastomotic leak in adult patients undergoing left-sided colorectal surgery?
Cohort (n=17,571)
Yes
Does the use of manual two-row circular staplers compared to three-row circular staplers reduce the risk of anastomotic leak in adult patients undergoing left-sided colorectal surgery?
Relative Risk: 0.72 (95% CI 0.52–1.01)
Absolute Event Rate: 7.78% vs 8.19%
In a large U.S. real-world cohort, manual two-row circular staplers demonstrated a similar risk of anastomotic leak compared to three-row devices in left-sided colorectal surgery.
Does not support preferring three-row staplers; leaves open need for randomized confirmation.
Purposes To compare the risk of anastomotic leak (AL) between Ethicon manual circular staplers (two-row) versus Medtronic EEA™ circular stapler with Tri-Staple™ technology (three-row) and between Medtronic EEA™ circular stapler with DST™ Series technology (two-row) versus Tri-Staple™ technology. Methods A retrospective cohort study was conducted in adult patients who underwent a left-sided colorectal surgery 2019–2022 in U.S. Premier Healthcare Database to assess the risk of AL within 30 days post-index procedure. The study devices were Ethicon manual circular staplers, Medtronic EEA™ circular stapler with DST™ technology, and Medtronic EEA™ circular stapler with Tri-Staple™ technology. Results Across 447 hospitals, the cumulative incidences (95% confidence intervals [CI]) of AL within 30 days post-index procedure were 7.78% (6.91–8.74%) among 8337 patients in the Ethicon manual circular stapler cohort, 7.54% (6.87–8.27%) among 7928 patients in the Medtronic EEA™ circular stapler with DST™ technology cohort, and 8.19% (6.57–10.07%) among 1306 patients in the Medtronic EEA™ circular stapler with Tri-Staple™ technology cohort. Comparative analyses revealed no difference comparing Ethicon manual circular staplers with Medtronic EEA™ circular staplers with Tri-Staple™ technology (risk ratio [RR], 0.72; 95% CI, 0.52–1.01) or comparing Medtronic EEA™ circular staplers with DST™ technology to Tri-Staple™ technology (RR, 0.75; 95% CI, 0.53–1.06). Conclusion In this analysis of a large cohort of patients undergoing a left-sided colorectal surgery from a U.S. hospital database, the risk of AL observed with manual two-row circular staplers was similar to that seen with three-row devices. This study affirms the safety of manual two-row circular staplers in colorectal anastomosis.
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Wang et al. (2023) conducted a cohort in Left-sided colorectal surgery (n=17,571). Ethicon manual circular staplers (two-row) vs. Medtronic EEA circular stapler with Tri-Staple technology (three-row) was evaluated on Anastomotic leak within 30 days post-index procedure (RR 0.72, 95% CI 0.52-1.01). Two-row manual circular staplers were associated with a similar risk of anastomotic leak within 30 days post-procedure compared to three-row devices in patients undergoing left-sided colorectal surgery (RR 0.72).
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