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Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis

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Abstract

Background

Several univariate and multivariate studies have already identified the number of stapler firings for laparoscopic rectal transection for rectal cancer as an independent risk factor for anastomotic leakage. The aim of this study was to perform a systematic review and meta-analysis of the anastomotic leakage rate in laparoscopic rectal surgery according to the need of using one or two stapler firings for rectal transection.

Methods

PubMed, Ovid, the Cochrane Library database and ClinicalTrials.gov were searched. All of the statistical analyses were performed using Revman software.

Results

Five studies were included (1267 patients). The overall anastomotic leakage rate was 5.5% [0.7–8.4%]. Anastomotic leak occurred in 3.5% (17/491) of the cases where 1 stapler firing was used versus 6.7% (50/786) of the cases in which 2 firings were needed (50/786). Two stapler firings were significantly associated with an increased risk of anastomotic leakage (OR 2.44, 95% CI 1.34–4.42, p = 0.003, I2 = 1%).

Conclusions

Our systematic review and meta-analysis suggest that two firings imply a higher rate of anastomotic leak than a single firing after laparoscopic rectal surgery with a double stapling technique. Coloproctologists should strive to reduce the number of linear stapler firings and try to transect the rectum with a single firing.

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Abbreviations

AL:

Anastomotic leakage

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Authors and Affiliations

  1. Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain

    Z. Balciscueta, N. Uribe, L. Caubet, M. López, I. Torrijo, J. Tabet & M. C. Martín

Authors
  1. Z. Balciscueta
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  2. N. Uribe
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  3. L. Caubet
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  4. M. López
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  5. I. Torrijo
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  6. J. Tabet
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  7. M. C. Martín
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Contributions

Study conception design, data acquisition and data analysis and interpretation: ZB and NU. Drafting the article and critical revision: ZB and NU. Final approval of the manuscript: ZB, NU, LC, ML, IT, JT and MCM.

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Correspondence to Z. Balciscueta.

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This manuscript has been one of the best five podium meeting presentations in XXIII Reunión Nacional Fundación Asociación Española de Coloproctología (Valladolid, Spain,15–17th May 2019).

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Balciscueta, Z., Uribe, N., Caubet, L. et al. Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis. Tech Coloproctol 24, 919–925 (2020). https://doi.org/10.1007/s10151-020-02240-7

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  • DOI: https://doi.org/10.1007/s10151-020-02240-7

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