1
|
Lie JJ, Samarasinghe N, Karimuddin AA, Brown CJ, Phang PT, Raval MJ, Ghuman A. Anastomotic leak rate following the implementation of a powered circular stapler in elective colorectal surgeries: a retrospective cohort study. Surg Endosc 2024; 38:5541-5546. [PMID: 39060622 DOI: 10.1007/s00464-024-11082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/13/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND The objective of this study was to compare the anastomotic leak rates between powered and manual circular staplers in elective left-sided colorectal resections. METHODS A retrospective cohort study of elective left-sided colorectal resections before and after implementation of a powered circular stapler at a tertiary care center was conducted. The manual stapler group consisted of consecutive resections performed between January 2016 to December 2016 and the powered stapler group, between September 2021 and December 2022. Primary outcome was 30-day anastomotic leak rate. A chi-squared analysis was performed to compare anastomotic leak rates. Factors associated with anastomotic leak were examined. RESULTS Two-hundred forty-seven patients were included: 154 in the manual stapler group and 93 in the powered stapler group. Mean (SD) age was 60 (15) years old, 37.7% were female and 72.9% of resections were performed for malignancy. Both groups had similar patient characteristics and surgical technique. Overall leak rate was 2.0% in the manual stapler group and 10.8% in the powered stapler group. The powered staplers were found to have 6.06 times the odds of leak compared to manual staplers (95% CI, 1.62-22.65; p = 0.01). None of the other factors were found to be associated with anastomotic leak. CONCLUSIONS Patients who had left-sided colorectal anastomosis had higher anastomotic leak rates with powered compared to manual circular staplers. This finding is contrary to previous retrospective studies that found lower leak rates with powered staplers.
Collapse
Affiliation(s)
- Jessica J Lie
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Ahmer A Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - Carl J Brown
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - P Terry Phang
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - Manoj J Raval
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - Amandeep Ghuman
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada.
- Department of Surgery, University of British Columbia, Colorectal Surgeon, St. Paul's Hospital, 1081 Burrard St, Rm C310, Vancouver, BC, V6Z 1Y6, USA.
| |
Collapse
|
2
|
Lee H, Yoon YS, Kim YI, Park EJ, Kim MH, Lee JL, Kim CW, Park IJ, Lim SB. The impact of powered circular staplers on anastomotic leak in left-sided colorectal cancer surgeries. Surg Endosc 2024; 38:6111-6119. [PMID: 39266757 PMCID: PMC11473663 DOI: 10.1007/s00464-024-11215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Hayoung Lee
- 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
| | - Yong Sik Yoon
- 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.
| | - Young Il Kim
- 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
| | - Eun Jung Park
- 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
| | - Min Hyun Kim
- 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
| | - Jong Lyul Lee
- 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
| | - Chan Wook Kim
- 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
| | - In Ja Park
- 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
| | - Seok-Byung Lim
- 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
| |
Collapse
|
3
|
Pla-Martí V, Martín-Arévalo J, Moro-Valdezate D, García-Botello S, Pérez-Santiago L, Barrachina-Martinez I, González-de-Julián S, Vivas-Consuelo D, Espí-Macías A. Incidence of anastomotic leakage using powered circular staplers versus manual circular staplers for left colorectal anastomosis: a cost-effectiveness analysis. Tech Coloproctol 2024; 28:76. [PMID: 38954099 PMCID: PMC11219427 DOI: 10.1007/s10151-024-02936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/15/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Colorectal anastomotic leakage causes severe consequences for patients and healthcare system as it will lead to increased consumption of hospital resources and costs. Technological improvements in anastomotic devices could reduce the incidence of leakage and its economic impact. The aim of the present study was to assess if the use of a new powered circular stapler is cost-effective. METHOD This observational study included patients undergoing left-sided circular stapled colorectal anastomosis between January 2018 and December 2021. Propensity score matching was carried out to create two comparable groups depending on whether the anastomosis was performed using a manual or powered circular device. The rate of anastomotic leakage, its severity, the consumption of hospital resources, and its cost were the main outcome measures. A cost-effectiveness analysis comparing the powered circular stapler versus manual circular staplers was performed. RESULTS A total of 330 patients were included in the study, 165 in each group. Anastomotic leakage rates were significantly different (p = 0.012): 22 patients (13.3%) in the manual group versus 8 patients (4.8%) in the powered group. The effectiveness of the powered stapler and manual stapler was 98.27% and 93.69%, respectively. The average cost per patient in the powered group was €6238.38, compared with €9700.12 in the manual group. The incremental cost-effectiveness ratio was - €74,915.28 per patient without anastomotic complications. CONCLUSION The incremental cost of powered circular stapler compared with manual devices was offset by the savings from lowered incidence and cost of management of anastomotic leaks.
Collapse
Affiliation(s)
- V Pla-Martí
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain.
- Department of Surgery, University of Valencia, Valencia, Spain.
| | - J Martín-Arévalo
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - D Moro-Valdezate
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - S García-Botello
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - L Pérez-Santiago
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - I Barrachina-Martinez
- Research Unit for Health Economics and Management, Universitat Politècnica de València, Camino de Vera S/N, 46022, Valencia, Spain
| | - S González-de-Julián
- Research Unit for Health Economics and Management, Universitat Politècnica de València, Camino de Vera S/N, 46022, Valencia, Spain
| | - D Vivas-Consuelo
- Research Unit for Health Economics and Management, Universitat Politècnica de València, Camino de Vera S/N, 46022, Valencia, Spain
| | - A Espí-Macías
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| |
Collapse
|
4
|
Martín-Arévalo J, Pla-Martí V, Huntley D, García-Botello S, Pérez-Santiago L, Izquierdo-Moreno A, Garzón-Hernández LP, Garcés-Albir M, Espí-Macías A, Moro-Valdezate D. Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis. Int J Colorectal Dis 2024; 39:51. [PMID: 38607585 PMCID: PMC11014877 DOI: 10.1007/s00384-024-04625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these circular staplers would have a lower risk of presenting a leak (AL) and/or anastomotic bleeding (AB). METHODS An in-depth search was carried out in the electronic bibliographic databases Embase, PubMed and SCOPUS. Observational studies were included, since randomized clinical trials comparing circular staplers were not found. RESULTS In the case of AL, seven studies met the inclusion criteria in the PCS group and four in the TRCS group. In the case of AB, only four studies could be included in the analysis in the PCS group. The AL OR reported for PCS was 0.402 (95%-confidence interval (95%-CI): 0.266-0.608) and for AB: 0.2 (95% CI: 0.08-0.52). The OR obtained for AL in TRCS was 0.446 (95%-CI: 0.217 to 0.916). Risk difference for AL in PCS was - 0.06 (95% CI: - 0.07 to - 0.04) and in TRCS was - 0.04 (95%-CI: - 0.08 to - 0.01). Subgroup analysis did not report significant differences between groups. On the other hand, the AB OR obtained for PCS was 0.2 (95% CI: 0.08-0.52). In this case, no significant differences were observed in subgroup analysis. CONCLUSION PCS presented a significantly lower risk of leakage and anastomotic bleeding while TRCS only demonstrated a risk reduction in AL. Risk difference of AL was superior in the PCS than in TRCS.
Collapse
Affiliation(s)
- José Martín-Arévalo
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain.
- Department of Surgery, University of Valencia, Valencia, Spain.
| | - Vicente Pla-Martí
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - Dixie Huntley
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - Stephanie García-Botello
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - Leticia Pérez-Santiago
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - A Izquierdo-Moreno
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Instituto Valenciano de Oncología, Valencia, Spain
| | - L P Garzón-Hernández
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - M Garcés-Albir
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Anatomy, University of Valencia, Valencia, Spain
| | - A Espí-Macías
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - David Moro-Valdezate
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| |
Collapse
|
5
|
Dai X, Zheng J, Yu X, Liu Z, Zheng L, Chen Z, Wang C. Mechanical properties and tissue damage caused by staples in gastrointestinal anastomosis. Proc Inst Mech Eng H 2024; 238:33-44. [PMID: 38156406 DOI: 10.1177/09544119231216283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Gastrointestinal surgery using a stapler is usually associated with tissue damage, anastomosis leakage, bleeding, and other complications, which is one of the effective methods for treating digestive tract cancer. The cutting properties of staples and the tissue damage occurring in the process of stapling porcine esophageal and gastric tissues have been evaluated and a new type of stapler has been designed. Since different structural and mechanical properties esophageal and gastric tissues layers, the puncturing force exhibits a fluctuating trend. Compressive stress caused by the bending of the staple legs can lead to the destruction of the vascular network inside the tissue, tissue deforms and tears. Finally, a staple with an internal incision arc (IIA) tip is designed, which meeting the performance requirements.
Collapse
Affiliation(s)
- Xuan Dai
- School of Electro-Mechanical Engineering, Guangdong University of Technology, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Junjie Zheng
- School of Electro-Mechanical Engineering, Guangdong University of Technology, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Xiaoli Yu
- Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhihua Liu
- School of Electro-Mechanical Engineering, Guangdong University of Technology, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, Guangdong, China
- Zhuhai Ton-Bridge Medical Technology Co., Ltd., Zhuhai, Guangdong, China
| | - Lijuan Zheng
- School of Electro-Mechanical Engineering, Guangdong University of Technology, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Zhihua Chen
- School of Electro-Mechanical Engineering, Guangdong University of Technology, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Chengyong Wang
- School of Electro-Mechanical Engineering, Guangdong University of Technology, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, Guangdong, China
| |
Collapse
|
6
|
Matsuhashi N, Tajima JY, Yokoi R, Kiyama S, Endo M, Sato Y, Kuno M, Hayashi H, Asai R, Fukada M, Yasufuku I, Tanaka Y, Okumura N, Murase K, Ishihara T, Takahashi T. Short-term outcomes associated with the use of a new powered circular stapler for rectal reconstructions: a retrospective study comparing it to manual circular staplers using inverse probability of treatment weight analysis. BMC Surg 2023; 23:332. [PMID: 37898761 PMCID: PMC10613387 DOI: 10.1186/s12893-023-02218-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/04/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The most common postoperative complication in malignant rectal surgery is anastomotic leakage (AL). AL after anterior or low anterior resection in rectal tumors is a fatal postoperative complication. Recently, the first automated suture circular stapler, which is expected to reduce the incidence of AL, (J&J). MATERIALS AND METHODS: This study included a total of 248 rectal tumor patients who underwent double stapler technique (DST) anastomotic procedures in the department of gastroenterological surgery /pediatric surgery at Gifu University School of Medicine from January 2017 to December 2021. The experience of a single institution utilizing the The Echelon circular™ stapler (ECP stapler:Manual VS Automatic) in rectal surgery cases was evaluated retrospectively from maintained database. RESULT One hundred thirty-nine patients (58.4%) were performed by manual circular stapling, 99 patients (41.6%) by powerd circular stapling. Diverting stoma was performed in 45 cases (32.4%) by manual circular stapling, 42 patients (42.4%) by powerd circular stapling Postoperative complications were occurred clavien-dindo grade II or higher in 57 cases (23.9%) and grade III or higher in 20 cases (8.4%). Anastomotic leakage occurred in 14 patients (5.9%) within all grades. After IPTW, the variables of patient characteristics was SMD ≤ 0.2 (Table.3), and there was a significant difference in anastomotic leakage (Odds Ratio (OR), 0.57; 95% Confidence Interval(CI), 0.34-0.98; p = 0.041). In addition, there was no significant difference in postoperative complications in grade II or higher (OR, 0.88; 95%CI, 0.65-1.19; p = 0.417) and grade III or higher (OR, 0.46; 95%CI, 0.29-0.74; p = 0.001) were significantly remarkable lower in powered circular stapling group. CONCLUSION In this IPTW comparison of patients undergoing rectal reconstructions, the ECP trial cohort had lower risks of several surgical complications AL and statistically signifcant lower rates of ileus/bowel obstruction, infection, and bleeding as Clavien-Dindo ≥ grade II and III as compared with for whom manual circular staplers were used.
Collapse
Affiliation(s)
- Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
| | - Jesse Yu Tajima
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Ryoma Yokoi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Shigeru Kiyama
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masahide Endo
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Yuta Sato
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masashi Kuno
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Hirokatsu Hayashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Ryuichi Asai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Katsutoshi Murase
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Takao Takahashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| |
Collapse
|
7
|
Vignali A, Gozzini L, Gasparini G, Calef R, Rosati R, Elmore U. Impact of powered circular stapler on anastomotic leak after anastomosis to the rectum: a propensity score matched study. Int J Colorectal Dis 2023; 38:211. [PMID: 37561203 DOI: 10.1007/s00384-023-04506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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). CONCLUSIONS The powered circular stapler has no impact on AL, while it could affect bleeding rate at the anastomotic site.
Collapse
Affiliation(s)
- Andrea Vignali
- Department of Coloproctology and Inflammatory Bowel Disease, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Lorenzo Gozzini
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e salute University, Milan, Italy
| | - Giulia Gasparini
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e salute University, Milan, Italy
| | - Riccardo Calef
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e salute University, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e salute University, Milan, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Vita e salute University, Milan, Italy
| |
Collapse
|
8
|
Wu Z, Zhou ZG, Li LY, Gao WJ, Yu T. Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer: A prospective case-control study. World J Gastrointest Surg 2023; 15:1354-1362. [PMID: 37555119 PMCID: PMC10405104 DOI: 10.4240/wjgs.v15.i7.1354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Gastric cancer is the most common cause of cancer-related deaths, and is classified according to its location in the proximal, middle, or distal stomach. Surgical resection is the primary approach for treating gastric cancer. This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer. AIM To explore the efficacy of different staplers and digestive tract reconstruction (DTR) methods after radical gastrectomy and their influence on prognosis. METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study, with a follow-up period of 12-26 mo. The patients were assigned to four groups based on the stapler and DTR plan as follows: Billroth Ⅰ (B-I) reconstruction + linear stapler group (group A, 22 cases), B-I reconstruction + circular stapler group (group B, 22 cases), Billroth II (B-II) reconstruction + linear stapler group (group C, 22 cases), and B-II reconstruction + circular stapler group (group D, 21 cases). The pathological parameters, postoperative gastrointestinal function recovery, postoperative complications, and quality of life (QOL) were compared among the four groups. RESULTS No significant differences in the maximum diameter of the gastric tumors, total number of lymph nodes dissected, drainage tube removal time, QLQ (QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively, and incidence of complications were observed among the four groups (P > 0.05). However, groups A and C (linear stapler) had significantly lower intraoperative blood loss and significantly shorter anastomosis time, operation time, first fluid diet intake time, first exhaust time, and length of postoperative hospital stay (P < 0.05) than groups B and D (circular stapler). CONCLUSION Linear staplers offer several advantages for postoperative recovery. B-I and B-II reconstruction methods had similar effects on QOL. The optimal solution can be selected according to individual conditions and postoperative convenience.
Collapse
Affiliation(s)
- Zhen Wu
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Zhi-Gang Zhou
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Ling-Yu Li
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Wen-Jing Gao
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Ting Yu
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| |
Collapse
|
9
|
Shibutani M, Fukuoka T, Iseki Y, Kasashima H, Kitayama K, Maeda K. Impact of a circular powered stapler on preventing anastomotic leakage in patients with left-sided colorectal cancer: a retrospective study. BMC Surg 2023; 23:205. [PMID: 37464350 DOI: 10.1186/s12893-023-02104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The powered circular stapler, which was developed with the aim of providing reliable and reproducible anastomosis, provides complete anastomosis, resulting in a reduced risk of anastomotic leakage. The aim of this study was to compare the incidence of anastomotic leakage between a conventional manual circular stapler (MCS) and the ECHELON CIRCULAR™ Powered Stapler (ECPS) in patients with left-sided colorectal cancer who underwent anastomosis with the double stapling technique. METHODS A total of 187 patients with left-sided colorectal cancer who underwent anastomosis with the double stapling technique with a conventional MCS or the ECPS during surgery at Osaka City University Hospital between January 2016 and July 2022 were enrolled in this study. RESULTS The incidence of anastomotic leakage in the ECPS group was significantly lower than that in the MCS group (4.4% versus 14.3%, p = 0.048). Furthermore, even after propensity score matching, an association was found between the use of the ECPS and a reduced incidence of anastomotic leakage. CONCLUSION The ECPS has the potential to help reduce the rate of anastomotic leakage in left-sided colorectal surgery.
Collapse
Affiliation(s)
- Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan.
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| | - Yasuhito Iseki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| | - Hiroaki Kasashima
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| | - Kishu Kitayama
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| |
Collapse
|
10
|
Vanstraelen S, Coosemans W, Depypere L, Mandeville Y, Moons J, Van Veer H, Nafteux P. Real-life introduction of powered circular stapler for esophagogastric anastomosis: cohort and propensity matched score study. Dis Esophagus 2022; 36:6758201. [PMID: 36222069 PMCID: PMC10150171 DOI: 10.1093/dote/doac073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/12/2022] [Indexed: 12/11/2022]
Abstract
Anastomotic leakage after esophagectomy is one of the most feared complications, which results in increased morbidity and mortality. Our aim was to evaluate the impact of a powered circular stapler on complications after esophagectomy with intrathoracic anastomosis for esophageal cancer. Between May 2019 and July 2021, all consecutive oesophagectomies for cancer with intrathoracic anastomosis in a high-volume center were included in this retrospective study. Surgeons were free to choose either a manual or a powered circular stapler. Preoperative characteristics and postoperative complications were recorded in a prospective database, according to EsoData. Propensity score matching (age, body mass index, Eastern cooperative oncology group (ECOG) performance and neoadjuvant therapy) was conducted to reduce potential confounding. We included 128 patients. Powered and manual circular staplers were used in 62 and 66 patients, respectively. Fewer anastomotic leakages were observed with the powered stapler group (OR = 7.3 (95%CI: 1.58-33.7); [3.2% (n = 2) vs 19.7% (n = 13), respectively; p = 0.004]). After propensity score matching, this remained statistically significant (OR = 8.5 (95%CI: 1.80-40.1); [4.1% (n = 2) vs 20.4% (n = 10), respectively; p = 0.013]). Additionally, anastomotic diameter was significantly higher with the powered stapler (median: 29 mm (63.3%) vs 25 mm (57.1%), respectively; p < 0.0001). There was no significant difference in comprehensive complication index (p = 0.146). A decreased mean length of stay was observed in the powered stapler group (11.1 vs 18.7 days respectively; p = 0.022). Postoperative anastomotic leakage after esophageal resection was significantly reduced after the introduction of the powered circular stapler, consequently resulting in a reduced length of stay. Further evaluation on long-term strictures and quality of life are warranted to support these results.
Collapse
Affiliation(s)
- Stijn Vanstraelen
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Yannick Mandeville
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| |
Collapse
|
11
|
Pollack E, Johnston S, Petraiuolo WJ, Roy S, Galvain T. Economic Analysis of Leak Complications in Anastomoses Performed with Powered versus Manual Circular Staplers in Left-Sided Colorectal Resections: A US-Based Cost Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:531-540. [PMID: 34168470 PMCID: PMC8217739 DOI: 10.2147/ceor.s305296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To estimate the cost impact of using the ECHELON CIRCULAR™ Powered Stapler (ECP) compared with manual circular staplers (standard of care, SOC) among patients undergoing colectomy procedures that involve left-sided anastomosis. Methods A US hospital-based budget impact model was developed to estimate the impact of ECP in reducing the surgical complication of anastomotic leak. The incremental acquisition cost of ECP vs SOC was compared to the net potential savings from reduced complication costs. The model was based on complication rates from a recently published matching-adjusted indirect comparison (MAIC) that compared clinical and healthcare utilization outcomes of patients using ECP with those of a propensity score-matched retrospective SOC control cohort from a real-world clinical practice population. The model assessed total cost, average length of stay (LOS), proportion of patients with a non-home discharge, and all-cause readmission. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were conducted to evaluate the robustness of the model assumptions and inputs. Results Despite a higher device cost of $412 for ECP compared with $298 for a manual stapler, annual savings due to avoided complications with ECP was $53,987 for anastomotic leak, assuming 100 procedures per year with each type of circular stapler. ECP also helped to avoid 27 LOS days, 0.38 readmissions and 0.22 non-home discharges. Sensitivity analyses around potential drivers of costs established the robustness of economic savings with the use of ECP - with annual savings being most impacted by the probability of anastomotic leak complication in the DSA. Conclusion This model demonstrates that among patients undergoing left-sided colectomy procedures, the incremental cost of using the ECHELON CIRCULAR™ Powered Stapler instead of a manual circular stapler was offset by the savings from lowered incidence and cost of management of anastomotic leaks in the hospital setting.
Collapse
Affiliation(s)
- Esther Pollack
- Franchise Health Economics and Market Access, Ethicon, Blue Ash, OH, USA
| | - Stephen Johnston
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | | | - Sanjoy Roy
- Franchise Health Economics and Market Access, Ethicon, Blue Ash, OH, USA
| | - Thibaut Galvain
- Global Health Economics, Johnson and Johnson Medical Devices, New Brunswick, NJ, USA
| |
Collapse
|
12
|
Sylla P, Sagar P, Johnston SS, Dwarakanathan HR, Waggoner JR, Schwiers M, Roy S. Outcomes associated with the use of a new powered circular stapler for left-sided colorectal reconstructions: a propensity score matching-adjusted indirect comparison with manual circular staplers. Surg Endosc 2021; 36:2541-2553. [PMID: 34031743 PMCID: PMC8921098 DOI: 10.1007/s00464-021-08542-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
Background This was a retrospective, matching-adjusted indirect comparison of clinical outcomes between patients from a single-arm trial of the ECHELON CIRCULAR™ Powered Stapler (ECP) and those from a historical cohort of patients who underwent left-sided colorectal resection using conventional manual circular staplers, extracted from the Premier Healthcare Database. Methods Patients in the ECP trial cohort were propensity score matched to those in the historical cohort through nearest neighbor matching. Outcomes included 30-day readmission rates; length of stay (LOS) for the index admission; rates of anastomotic leak, pelvic abscess, ileus/small bowel obstruction, infection, bleeding, and stoma creation. Results The study included 168 patients in the ECP trial cohort and 4544 patients in the historical cohort; 165 ECP trial patients were matched to 1348 historical cohort patients. After matching, conversions were more prevalent in the historical cohort than the ECP trial cohort (4.2% ECP vs. 10.2% historical, p = 0.001). Relative to the historical cohort, the ECP trial cohort had statistically significant lower rates of 30-day inpatient readmission (6.1% vs. 10.8%, p = 0.019), anastomotic leak (1.8% vs. 6.9%, p < 0.001), ileus/small bowel obstruction (4.8% vs. 14.7%, p < 0.001), infection (1.8% vs. 5.7%, p = 0.001), and bleeding (1.8% vs. 9.2%, p < 0.001) during the index admission or within 30 days thereafter. No statistically significant differences in rates of pelvic abscess, stoma creation, or LOS were found between the two cohorts. Three sensitivity analyses to address the difference in conversion rates yielded largely consistent results, with loss of statistical significance for inpatient admission in some cases. This study is limited by its potential for differences in unmeasurable factors between the ECP trial and historical cohorts. Conclusions In this study, the ECP trial cohort had lower incidence proportions of several surgical complications as compared with the historical cohort. Further controlled prospective clinical studies are needed to confirm the validity of this finding. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08542-7.
Collapse
Affiliation(s)
- Patricia Sylla
- Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Sagar
- John Goligher Colorectal Department, St James' University Hospital, Leeds, UK
| | - Stephen S Johnston
- Real-World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, 410 George Street, New Brunswick, NJ, USA.
| | | | | | | | - Sanjoy Roy
- Ethicon Endo-Surgery, Inc, Cincinnati, OH, USA
| |
Collapse
|
13
|
Fortin SP, Johnston SS, Chaudhuri R, Fryrear R, Roy S. Incidence, predictors, and economic burden of circular anastomotic complications in left-sided colorectal reconstructions involving manual circular staplers. J Med Econ 2021; 24:255-265. [PMID: 33576292 DOI: 10.1080/13696998.2021.1880749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
STUDY AIM Manual circular staplers are widely used in colorectal surgery; however, limited literature exists examining complications related to circular anastomoses when such devices are used. The present study evaluated the incidence, predictors, and economic burden of circular anastomotic complications in left-sided colorectal reconstructions involving manual circular staplers. MATERIALS AND METHODS Patients aged ≥18 years who underwent hemicolectomy, low anterior resection, or sigmoidectomy between 1 October 2016 and 31 December 2018 were identified from the Premier Healthcare Database. Manual circular stapler use was identified from hospital administrative billing records. Circular anastomotic complications were defined as a composite endpoint of multiple circular stapler use (proxy for stapler failure) or other circular anastomotic complications (anastomotic leak, bleeding, device/surgical complications, infection, and transfusion). Multivariable analyses were used to model the associations between circular anastomotic complications and total hospital costs, length of stay, operating room time, and 30-, 60-, and 90-day readmission rates. RESULTS A total of 13,167 patients met the study criteria, of whom 2,984 (22.7%) had circular anastomotic complications. Predictors of circular anastomotic complications included age, procedure type, provider region, and select patient comorbidities. As compared with those who did not, patients who suffered circular anastomotic complications had significantly higher adjusted total hospital costs ($26,924 vs. $18,748; p < .0001), length of stay (7.79 vs. 4.99 days; p < .0001), operating room time (280 vs. 239 min; p < .0001), non-home discharge status (9.63% vs. 4.61%; p < .0001), and all-cause readmission at 30 days (12.2% vs. 8.7%; p < .0001), 60 days (16.0% vs. 11.6%; p < .0001), and 90 days (18.5% vs. 13.4%; p < .0001). LIMITATIONS The present study is limited by the observational nature and potential for measurement error that is inherent to administrative healthcare databases. CONCLUSIONS In this analysis of patients undergoing left-sided colorectal reconstructions involving a manual circular stapler, circular anastomotic complications were associated with adverse economic consequences.
Collapse
Affiliation(s)
- Stephen P Fortin
- Medical Devices - Epidemiology, Johnson & Johnson Co., New Brunswick, NJ, USA
| | - Stephen S Johnston
- Medical Devices - Epidemiology, Johnson & Johnson Co., New Brunswick, NJ, USA
| | | | - Raymond Fryrear
- Preclinical, Clinical, Medical Centre, Ethicon Inc., Cincinnati, OH, USA
| | - Sanjoy Roy
- Franchise Health Economics and Market Access, Ethicon Inc., Cincinnati, OH, USA
| |
Collapse
|
14
|
Herzig DO, Ogilvie JW, Chudzinski A, Ferrara A, Ashraf SQ, Jimenez-Rodriguez RM, Van der Speeten K, Kinross J, Schimmelpenning H, Sagar PM, Cannon JA, Schwiers ML, Singleton DW, Waggoner JR, Fryrear R, Sylla P. Assessment of a circular powered stapler for creation of anastomosis in left-sided colorectal surgery: A prospective cohort study. Int J Surg 2020; 84:140-146. [PMID: 33176211 DOI: 10.1016/j.ijsu.2020.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Circular staplers perform a critical function for creation of anastomoses in colorectal surgeries. Powered stapling systems allow for reduced force required by surgeons to fire the device and may provide advantages for creating a secure anastomosis. The objective of this study was to evaluate the clinical performance of a novel circular powered stapler in a post-market setting, during left-sided colectomy procedures. MATERIALS AND METHODS Consecutive subjects underwent left-sided colorectal resections that included anastomosis performed with the ECHELON CIRCULAR™ Powered Stapler (ECP). The primary endpoint was the frequency in which a stapler performance issue was observed. Secondary endpoints included evaluation of ease of use of the device via a surgeon satisfaction questionnaire, and monitoring/recording of procedure-related adverse events (AEs). RESULTS A total of 168 anastomoses were performed with the ECP. Surgical approaches included robotic-assisted (n = 74, 44.0%), laparoscopic (n = 71, 42.3%), open (n = 20, 11.9%), and hand-assisted minimally invasive (n = 3, 1.8%) procedures. There were 22 occurrences of device performance issues in 20 (11.9%) subjects during surgery. No positive intraoperative leak tests were observed, and only 1 issue was related to a procedure-related AE or surgical complication, which was an instance of incomplete surgical donut necessitating re-anastomosis. Postoperative anastomotic leaks were experienced in 4 (2.4%) subjects. Clavien-Dindo classification of all AEs indicated that 92.0% were Grades I or II. Participating surgeons rated the ECP as easier to use compared to previously used manual circular staplers in 85.7% of procedures. CONCLUSION The circular powered stapler exhibited few clinically relevant performance issues, an overall favorable safety profile, and ease of use for creation of left-sided colon anastomoses.
Collapse
Affiliation(s)
- Daniel O Herzig
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - James W Ogilvie
- Spectrum Health, 4100 Lake Dr SE STE 205, Grand Rapids, MI, USA
| | - Allen Chudzinski
- AdventHealth Tampa, 3000 Medical Park Dr #500, Tampa, FL, 33611, USA
| | | | - Shazad Q Ashraf
- University Hospitals Birmingham NHS, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | | | | | - James Kinross
- St. Mary's Hospital, Imperial College London, Praed St, Paddington, London, W2 1NY, UK
| | | | - Peter M Sagar
- St James's University Hospital, Beckett St, Leeds, LS9 7TF, UK
| | - Jamie A Cannon
- University of Alabama Birmingham School of Medicine, 2000 6th Ave S 1st Floor, Birmingham, AL, 35233, USA
| | | | | | - Jason R Waggoner
- Ethicon Endo-Surgery, Inc, 4545 Creek Rd, Blue Ash, OH, 45242, USA
| | - Raymond Fryrear
- Ethicon Endo-Surgery, Inc, 4545 Creek Rd, Blue Ash, OH, 45242, USA
| | - Patricia Sylla
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 5 E 98th St 14th Fl, Ste D, New York, NY, 10029, USA
| |
Collapse
|
15
|
Impact of the novel powered circular stapler on risk of anastomotic leakage in colorectal anastomosis: a propensity score-matched study. Tech Coloproctol 2020; 25:279-284. [PMID: 32914268 DOI: 10.1007/s10151-020-02338-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
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 left-sided 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.
Collapse
|