A comparative clinical outcome study of power-assisted vs. manually-operated circular staplers for deep colorectal anastomosis

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INTRODUCTION: The objective of this study is to compare the perioperative clinical outcomes between power-assisted circular staplers (PCS) and manually-operated circular staplers (MCS) with directional stapling technology (DST) for deep colorectal anastomoses. MATERIALS AND METHODS: A retrospective analysis of a prospective database of 64 consecutive patients who underwent elective surgery for low colorectal anastomosis (< 7 cm from the anal verge) between February 2020 and December 2022 at a tertiary referral center for colorectal surgery at the University Hospital of Tours, France. Patients were divided into two groups according to the stapler used: PCS group II; (n = 35) and MCS (group I; n = 29). Data collected included demographic characteristics, intraoperative parameters, postoperative complications (Dindo-Clavien), and oncological outcomes. RESULTS: The PCS group had significantly lower overall rates of postoperative complications compared to the MCS group (31.4% vs. 62%, p = 0.022). In particular, anastomotic bleeding (AB) was less frequent in the PCS group (0% vs. 17.2%, p = 0.015). While no significant differences in recurrence or survival events were observed between groups during follow-up, the PCS group demonstrated a lower incidence of symptomatic anastomotic leaks (8.6% vs.13.6%, p = 0.069) and postoperative ileus (0% vs. 20.7%, p = 0.025). CONCLUSION: In our study, the use of PCS for deep rectal anastomosis was associated with a significantly lower overall postoperative complication rate, rate of symptomatic anastomotic leackage (AL) and AB. Our data support the potential preferential use of PCS in clinical practice. However, larger prospective randomized trials should be conducted to further investigate the potential clinical benefits and cost-effectiveness of using PCS in selected patient populations.

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