Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
Surg Endosc. 2024 Oct;38(10):6111-6119. doi: 10.1007/s00464-024-11215-w. Epub 2024 Sep 12.
Since the introduction of powered circular staplers in colorectal surgery, there has been growing interest in their impact on reducing complications, particularly anastomotic leakage. This study compared short-term postoperative outcomes between powered and manual circular staplers.
This retrospective study included colorectal cancer patients at the tertiary referral center from April to October 2023 who underwent anterior or low anterior resection (LAR) using a circular stapler. According to energy source, patients were divided into powered and manual groups, which used two powered and four types of manual staplers, respectively. All open, laparoscopic, and robotic approaches were included. Propensity score matching (PSM) analysis was used to reduce selection bias. Postoperative complications within 30 days, especially for anastomosis-related complications, were compared between the groups.
Among 511 patients, the powered group was 161 (32%). After PSM, 143 pairs of 286 patients were analyzed. The proportions of LAR were 53.8% and 51.0%, and initial diverting stoma rates were 23.1% and 22.4% for the Powered and Manual groups, respectively. Comprehensive complication rates were similar between the Powered group and the Manual group, without statistical significance (13.3% vs. 21.0%, P = 0.063). Anastomotic leakage was not different between the Powered and Manual groups (4.2% vs. 4.9%, P = 0.782). There was no significant difference in other complications, including anastomotic bleeding, ileus, surgical site infection, and intra-abdominal hematoma.
The study implies that powered circular staplers may not significantly reduce postoperative complications, including anastomotic leakages, compared to manual staplers in colorectal surgery of high-volume centers.
自在结直肠手术中引入电动圆形吻合器以来，人们越来越关注其减少并发症的作用，尤其是吻合口漏。本研究比较了电动和手动圆形吻合器对短期术后结果的影响。
本回顾性研究纳入了 2023 年 4 月至 10 月在三级转诊中心接受圆形吻合器行前侧或低位前切除术（LAR）的结直肠癌患者。根据能量源，患者分为电动组和手动组，分别使用两种电动和四种手动吻合器。所有开放、腹腔镜和机器人方法均包括在内。采用倾向评分匹配（PSM）分析来减少选择偏倚。比较两组患者术后 30 天内的并发症，尤其是吻合口相关并发症。
在 511 例患者中，电动组为 161 例（32%）。经 PSM 后，分析了 143 对 286 例患者。LAR 的比例分别为 53.8%和 51.0%，初始转流造口率分别为电动组和手动组的 23.1%和 22.4%。电动组和手动组的综合并发症发生率相似，无统计学意义（13.3%比 21.0%，P=0.063）。吻合口漏在电动组和手动组之间无差异（4.2%比 4.9%，P=0.782）。其他并发症如吻合口出血、肠梗阻、手术部位感染和腹腔内血肿在两组之间也没有显著差异。
本研究表明，在高容量中心的结直肠手术中，与手动吻合器相比，电动圆形吻合器可能不会显著降低术后并发症，包括吻合口漏。
