Impact of the novel powered circular stapler on risk of anastomotic leakage in colorectal anastomosis: a propensity scor
- PDF / 564,057 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 29 Downloads / 252 Views
ORIGINAL ARTICLE
Impact of the novel powered circular stapler on risk of anastomotic leakage in colorectal anastomosis: a propensity score‑matched study V. Pla‑Martí1,2 · J. Martín‑Arévalo1 · D. Moro‑Valdezate1,2 · S. García‑Botello1,2 · I. Mora‑Oliver1 · R. Gadea‑Mateo1 · C. Cozar‑Lozano1 · A. Espí‑Macías1,2 Received: 21 April 2020 / Accepted: 3 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background Several risk factors for anastomotic leakage (AL) following colorectal surgery have been described. Improvement in devices for performing anastomosis is a modifiable factor that could reduce AL rates. The aim of this study was to assess the impact of technical improvements in the Echelon Circular™ powered stapler (ECPS) on the left-sided colorectal AL rate compared to current manual circular staplers (MCS). Methods A cohort study was carried out on consecutive patients between January 2017 and February 2020 in whom leftsided stapled colorectal anastomosis above 5 cm from anal verge was performed. The primary end point was the risk of AL depending on the type of circular stapler used. The ECPS cases were matched to MCS cases by propensity score matching to obtain comparable groups of patients. Results Two hundred seventy-nine patients met the inclusion criteria. A MCS anastomosis was performed in 218 patients and ECPS anastomosis in 61 (21.9%). Overall, AL was observed in 25 (9%) cases. Factors significantly associated with AL were American Society of Anesthesiologists score (p = 0.025) and type of circular stapler used (p = 0.021). After adjusting the cases with propensity score matching (119 cases MCS versus 60 ECPS), AL was observed in 14 (11.8%) patients in MCS group and in 1 (1.7%) patient in the ECPS group (p = 0.022). AL in the MCS group required reoperation in seven cases (5.8%), the remaining seven patients were treated conservatively. The patient in the ECSP group required an urgent Hartmann’s procedure Conclusions The ECPS device could have a positive impact by reducing AL rates in left-sided colorectal anastomosis. Multicenter controlled trials are needed for stronger evidence to change practice. Keywords Colorectal anastomosis · Anastomotic leak · Echelon circular stapler · Powered circular stapler · Surgical stapler
Introduction Anastomotic leakage (AL) is the complication that most concerns colorectal surgeons. It leads to prolonged postoperative stay, increased costs, risk of reoperations and a permanent colostomy, together with an increase in morbidity and mortality [1]. Colorectal AL rates are associated with the anatomical location of the anastomosis. The incidence of * V. Pla‑Martí [email protected] 1
Department of Colorectal Surgery, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010 Valencia, Spain
Department of Surgery, University of Valencia, Valencia, Spain
2
leaks after left-sided anastomosis ranges from 1 to 23% [2]. Furthermore, it has been shown that AL in colorectal cancer patients affects long-term oncological outcomes increasing the
Data Loading...
