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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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Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

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

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Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Andrea Vignali.

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Ethics approval

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). https://doi.org/10.1007/s00384-023-04506-6

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