World Journal of Surgery

, Volume 42, Issue 10, pp 3097–3105 | Cite as

Association Between Circular Stapler Diameter and Stricture Rates Following Gastrointestinal Anastomosis: Systematic Review and Meta-analysis

  • W. Allen
  • C. I. Wells
  • M. Greenslade
  • I. P. Bissett
  • G. O’Grady
Scientific Review



Stricture is a common complication of gastrointestinal (GI) anastomoses, associated with impaired quality of life, risk of malnutrition, and further interventions. This systematic review and meta-analysis aimed to determine the association between circular stapler diameter and anastomotic stricture rates throughout the GI tract.


A systematic literature search of EMBASE, MEDLINE and Cochrane Library was performed. The primary outcome was the rate of radiologically or endoscopically confirmed anastomotic stricture. Pooled odds ratios (OR) were calculated using random-effects models to determine the effect of circular stapler diameter on stricture rates in different regions of the GI tract.


Twenty-one studies were identified: seven oesophageal, twelve gastric, and three lower GI. Smaller stapler sizes were strongly associated with higher anastomotic stricture rates throughout the GI tract. The oesophageal anastomosis studies showed; 21 versus 25 mm circular stapler: OR 4.39 ([95% CI 2.12, 9.07]; P < 0.0001); 25 versus 28/29 mm circular stapler: OR 1.71 ([95% CI 1.15, 2.53]; P < 0.008). Gastric studies showed; 21 versus 25 mm circular stapler: OR 3.12 ([95% CI 2.23, 4.36]; P < 0.00001); 25 versus 28/29 mm circular stapler: OR 7.67 ([95% CI 1.86, 31.57]; P < 0.005). Few lower GI studies were identified, though a similar trend was found: 25 versus 28/29 mm circular stapler: pooled OR 2.61 ([95% CI 0.82, 8.29]; P = 0.100).


The use of larger circular stapler sizes is strongly associated with reduced risk of anastomotic stricture in the upper GI tract, though data from lower GI joins are limited.

Supplementary material

268_2018_4606_MOESM1_ESM.pdf (41 kb)
Supplementary material 1 (PDF 41 kb)
268_2018_4606_MOESM2_ESM.docx (12 kb)
Supplementary material 2 (DOCX 12 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • W. Allen
    • 1
    • 2
  • C. I. Wells
    • 1
    • 2
  • M. Greenslade
    • 1
  • I. P. Bissett
    • 2
  • G. O’Grady
    • 1
    • 2
  1. 1.Surgical Engineering Laboratory, Auckland Bioengineering InstituteThe University of AucklandAucklandNew Zealand
  2. 2.Department of Surgery, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand

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