Department of Coloproctology and Inflammatory Bowel Disease, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e salute University, Milan, Italy.
Int J Colorectal Dis. 2023 Aug 10;38(1):211. doi: 10.1007/s00384-023-04506-6.
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.
本研究旨在评估 Echelon Circular 电动吻合器（PCS）对左半结直肠吻合口漏的影响，并将结果与传统的圆形吻合器（CCS）进行比较。
对 2017 年 12 月至 2022 年 9 月间连续 552 例接受腹腔镜结直肠切除和直肠吻合术的患者进行了一项单中心队列研究。使用倾向评分匹配将接受电动圆形吻合直肠的患者与接受传统吻合吻合的患者进行匹配。主要结局是吻合口漏（AL）发生率、吻合口出血和术后结局。
在调整了倾向评分匹配病例后，生成了两组新的患者：PCS 组 145 例，CCS 组 145 例。两组在人口统计学和入院时的合并症方面具有同质性。总体而言，21 例（7.3%）患者发生 AL。两组在 AL 发生率（PCS 组为 5.5%，CCS 组为 9%；p=0.66）、瘘管严重程度（p=0.60）或再次手术率（p=0.65）方面无显著差异。CCS 组吻合口出血发生率高于 PCS 组（5.5%比 0.7%，p=0.03）。在倾向评分匹配后进行的单因素分析中，吻合器直径≥31mm 和年龄≥70 岁是唯一与吻合口漏显著相关的变量（p=0.001 和 p=0.031；分别）。
电动圆形吻合器对 AL 无影响，但可能会影响吻合口处的出血率。
