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

Abstract

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), the first automated suture stapler that is expected to reduce the incidence of AL. Materials and methods This study included a total of 248 rectal cancer patients who underwent double stapler technique 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 139 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, 99 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 inverse probability of treatment weighting (IPTW), the variables of patient characteristics was standardized mean difference ≤ 0.2, 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 of grade II or higher (OR, 0.88; 95% CI, 0.65–1.19; p = 0.417), and complications of grade III or higher (OR, 0.46; 95% CI, 0.29–0.74; p = 0.001) were significantly and remarkably lower in the 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.