Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133, Milan, Italy.
General Surgery Residency Program, University of Milan, Milan, Italy.
Int J Colorectal Dis. 2024 Sep 27;39(1):152. doi: 10.1007/s00384-024-04729-1.
Anastomotic leak (AL) remains the most important complication after left-sided colic anastomoses and technical complications during anastomotic construction are responsible of higher leakage incidence. Powered circular stapler (PCS) in colorectal surgery has been introduced in order to reduce technical errors and post-operative complications due to the manual circular stapler (MCS).
A systematic review and meta-analysis were performed. An electronic systematic search was performed using Web of Science, PubMed, and Embase of studies comparing PCS and MCS. The incidence of AL, anastomotic bleeding (AB), conversion, and reoperation were assessed. PROSPERO Registration Number: CRD42024512644.
Five observational studies were eligible for inclusion reporting on 2379 patients. The estimated pooled Risk Ratios for AL and AB rates following PCS were significantly lower than those observed with MCS (0.44 and 0.23, respectively; both with p < 0.01). Conversion and reoperation rate did not show any significant difference: 0.41 (95% CI 0.09-1.88; p = 0.25) and 0.78 (95% CI 0.33-1.84; p = 0.57); respectively.
The use of PCS demonstrates a lower incidence of AL and AB compared to MCS but does not exhibit a discernible influence on reintervention or conversion rates. The call for future randomized clinical trials aims to definitively clarify these issues and contribute to further advancements in refining surgical strategies for left-sided colonic resection.
吻合口漏（AL）仍然是左侧结肠吻合术后最重要的并发症，吻合口构建过程中的技术并发症是导致更高漏诊率的原因。为了减少手动吻合器（MCS）导致的技术误差和术后并发症，在结直肠手术中引入了电动圆形吻合器（PCS）。
进行了系统评价和荟萃分析。使用 Web of Science、PubMed 和 Embase 电子系统搜索比较 PCS 和 MCS 的研究。评估了 AL、吻合口出血（AB）、转换和再次手术的发生率。PROSPERO 注册号：CRD42024512644。
五项观察性研究符合纳入标准，共报告了 2379 例患者。与 MCS 相比，PCS 后 AL 和 AB 发生率的估计合并风险比显著降低（分别为 0.44 和 0.23，均 p < 0.01）。转换和再次手术率没有显著差异：0.41（95%CI 0.09-1.88；p = 0.25）和 0.78（95%CI 0.33-1.84；p = 0.57）。
与 MCS 相比，PCS 的使用显示出较低的 AL 和 AB 发生率，但对再干预或转换率没有明显影响。未来随机临床试验的呼吁旨在明确这些问题，并有助于进一步改进左侧结肠切除术的手术策略。
