Background/aim: The anastomotic leakage rate of the double stapling technique anastomosis in colorectal surgery remains high at approximately 10%. The Echelon Circular™ powered stapler (ECPS) has been recently reported to reduce the risk of anastomotic leakage. A meta-analysis was conducted to evaluate and compare the effectiveness of ECPS to that of the manual circular stapler (MCS) in left-sided colorectal resections.
Materials and methods: We searched publicly available literature databases for studies published between 2018 and August 2024. The following search terms were used: "powered circular stapler", "powered circular", "anastomosis", and "powered echelon". We analyzed several outcomes including anastomotic leakage, major anastomotic leakage, and anastomotic bleeding. A subgroup analysis was performed to analyze Japanese cases only.
Results: We identified 9 papers reporting results that compared ECPS for left-sided colorectal resection with MCS. Our meta-analysis included 3,301 patients with colorectal anastomosis; 1,135 had undergone ECPS and 2,166 had undergone MCS. The overall anastomotic leakage rate was significantly lower in the ECPS group than in the MCS group (p<0.0001). Regarding major anastomotic leakage, there was a tendency for the ECPS group to include fewer cases than the MCS group (p=0.10). For anastomotic bleeding, no significant difference was found between the two groups. In the subgroup analysis of Japanese patients, ECPS also showed significantly lesser anastomotic leakage than MCS.
Conclusion: ECPS may significantly reduce the rate of anastomotic leakage in left-sided colorectal surgery compared to MCS in both the Western and Asian populations.
Keywords: Powered circular stapler; anastomotic leakage; colorectal surgery; double stapling technique; meta-analysis; review.
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