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Impact of powered circular stapler on anastomotic leak after anastomosis to the rectum: a propensity score matched study

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International Journal of Colorectal Disease Aims and scope Submit manuscript



The aim of the present study is to assess the impact of Echelon Circular powered stapler (PCS) on left-sided colorectal anastomotic leaks and to compare results to conventional circular staplers (CCS).


A single center cohort study was carried out on 552 consecutive patients, who underwent laparoscopic colorectal resection and anastomosis to the rectum between December 2017 and September 2022. Patients who underwent powered circular anastomosis to the rectum were matched to those who had a conventional stapled anastomosis using a propensity score matching. Main outcomes were anastomotic leak (AL) rate, anastomotic bleeding, and postoperative outcomes.


After adjusting cases with propensity score matching, two new groups of patients were generated: 145 patients in the PCS and 145 in the CCS. The two groups were homogeneous with respect to demographics and comorbidities on admission. Overall, AL occurred in 21 (7.3%) patients. No significant differences were observed with respect to AL (5.5% in PCS vs 9% in CCS; p = 0.66), fistula severity (p = 0.60) or reoperation rate (p = 0.65) in the two groups in study. A higher rate of anastomotic bleeding was observed in the CCS vs PCS (5.5% vs 0.7%, p = 0.03). At univariate analysis performed after propensity score matching, stapler diameter ≥ 31mm and age ≥ 70 years were the only variable significantly associated with anastomotic leak (p = 0.001 and p = 0.031; respectively).


The powered circular stapler has no impact on AL, while it could affect bleeding rate at the anastomotic site.

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Data availability

The data that support the findings of this study are available on request from the corresponding author [AV]. The data are not publicly available due to restrictions, e.g., their containing information that could compromise the privacy of research participants.


  1. Qu H, Liu YDSB (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617.

    Article  PubMed  Google Scholar 

  2. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102:462–479.

    Article  CAS  PubMed  Google Scholar 

  3. Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113.

    Article  CAS  PubMed  Google Scholar 

  4. Braunschmid T, Hartig N, Baumann L, Dauser B, Herbst F (2017) Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate. Surg Endosc 31:5318–5326.

    Article  Google Scholar 

  5. Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis colon Rectum 43:76–82.

    Article  CAS  PubMed  Google Scholar 

  6. Balciscueta Z, Uribe N, Caubert L, Lopez M, Torrijo I, Taber J, Martin MC (2020) 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.

    Article  CAS  PubMed  Google Scholar 

  7. Herzig DO, Ogilvie JW, Chudzinski A, Ferrara A, Ashraf SQ, Jimenez-Rodriguez RM, Van der Speeten K, Kinross J, Schimmelpenning H, Sagar PM, Cannon JA, Schwiers ML, Singleton DW, Waggoner JR, Fryrear R, Sylla P (2020) Assessment of a circular powered stapler for creation of anastomosis in left-sided colorectal surgery: a prospective cohort study. Int J Surg 84:140–146.

    Article  PubMed  Google Scholar 

  8. Pla-Martí V, Martín-Arévalo J, Moro-Valdezate D, García-Botello S, Mora-Oliver I, Gadea-Mateo R, Cozar-Lozano C, Espí-Macías, (2021) Impact of the novel powered circular stapler on risk of anastomotic leakage in colorectal anastomosis: a propensity score-matched study. Tech Coloproctol 2325:279–284.

    Article  Google Scholar 

  9. Sylla P, Sagar P, Johnston SS, Dwarakanathan HR, Waggoner JR, Schwiers M, Roy S (2022) Outcomes associated with the use of a new powered circular stapler for left-sided colorectal reconstructions: a propensity score matching-adjusted indirect comparison with manual circular staplers. Surg Endosc 36:2541–2553.

    Article  PubMed  Google Scholar 

  10. De Nardi P, Elmore U, Maggi G, Maggiore R, Boni L, Cassinotti E, Fumagalli U, Gardani M, De Pascale S, Parise P, Vignali A, Rosati R (2020) Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc 34:53–60. Epub 2019 Mar 21

    Article  PubMed  Google Scholar 

  11. Armstrong G, Croft J, Corrigan N, Brown JM, Goh V, Quirke P, Hulme C, Tolan D, Kirby A, Cahill R, O’Connell PR, Miskovic D, Coleman Jayne M (2018) D.IntAct: intra-operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Dis 20:O226–O234. Epub 2018 Jun 8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Büchler MW (2010) Defnition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351.

    Article  PubMed  Google Scholar 

  13. Mirnezami A, Soares A, Chand M (2019) Enhancing the precision of circular stapled colorectal anastomosis: could powered stapler technology provide the solution? Tech Coloproctol 23:687–689.

    Article  CAS  Google Scholar 

  14. Offodile AC, Feingold DL, Nasar A, Whelan RL, Arnell TD (2010) High incidence of technical errors involving the EEA circular stapler: a single institution experience. J Am Coll Surg 210:331–335.

    Article  PubMed  Google Scholar 

  15. Chekan E (2014) Whelan RL (2014) Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. Med Devices 12(7):305–318.

    Article  Google Scholar 

  16. Atallah S, Kural S, Banda N, Banda A, Bawaney F, Cabral F, Neychev VC, Patel C, Larach S (2020) Initial clinical experience with a powered circular stapler for colorectal anastomosis. Tech Coloproctol 24:479–486.

    Article  CAS  PubMed  Google Scholar 

  17. Damgaard Eriksen J, Emmertsen KJ, Madsen AH, Erichsen R, Bachmann TN, Hjerrild Iversen L (2022) The impact of multiple firings on the risk of anastomotic leakage after minimally invasive restorative rectal cancer resection and the impact of anastomotic leakage on long-term survival: a population-based study. Int J Colorectal Dis 37:1335–1348.

    Article  PubMed  Google Scholar 

  18. Reif de Paula T, Simon H, Shah M, Lee-Kong S, Kiely JM, Kiran RP, Keller DS (2020) Analysis of the impact of EEA stapler size on risk of anastomotic complications in colorectal anastomosis: does size matter? Tech Coloproctol 24:283–290.

    Article  CAS  PubMed  Google Scholar 

  19. Jiang Y, Chen H, Kong M, Sun D, Sheng H (2022) Association between circular stapler size and anastomotic leakage after laparoscopic low anterior resection for rectal cancer. J Cnacer Res Ther 8:1931–1936.

    Article  Google Scholar 

  20. Heiss M, Mempel W, Delanoff C, Jauch KW, Gabka C, Mempel M, Dieterich HJ, Eissner HJ, Schildberg FW (1994) Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol 12(9):1859–1867.

    Article  CAS  PubMed  Google Scholar 

  21. Blumberg N, Chuang-Stein C, Heal JM (1990) The relationship of blood transfusion, tumor staging, and cancer recurrence. Transusion 30:291–294.

    Article  CAS  Google Scholar 

  22. Hanna DN, Hawkins AT (2021) Colorectal: management of postoperative complications in colorectal surgery. Surg Clin North Am 101:717–729.

    Article  PubMed  Google Scholar 

  23. Phitayakorn R, Delaney CP, Reynolds HL, Champagne BJ, Heriot AG, Neary P, Senagore AJ (2008) International Anastomotic Leak Study Group. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery World J Surg 32:1147–1156.

    Article  CAS  PubMed  Google Scholar 

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We are indepted with Dr La fauci Dario for his assistance in the cost analysis evaluation.

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Authors and Affiliations



All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Gozzini Lorenzo, Calef Riccardo, and Ugo Elmore. Giulia Gasparini did the statistical analysis of the data. The first draft of the manuscript was written by Andrea Vignali and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Andrea Vignali.

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Approval was waived by the local Ethics Committee of University-Vita e Salute. In view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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The authors declare no competing interests.

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Vignali, A., Gozzini, L., Gasparini, G. et al. Impact of powered circular stapler on anastomotic leak after anastomosis to the rectum: a propensity score matched study. Int J Colorectal Dis 38, 211 (2023).

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