Current evidence on powered versus manual circular staplers in colorectal surgery: a systematic review and meta-analysis.

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY International Journal of Colorectal Disease Pub Date : 2025-01-15 DOI:10.1007/s00384-025-04807-y

José Martín-Arévalo, David Moro-Valdezate, Leticia Pérez-Santiago, Fernando López-Mozos, Carlos Javier Peña, Juan Antonio Carbonell Asins, David Casado Rodrigo, Stephanie García-Botello, Claudia Gil-Alfosea, Vicente Pla-Martí

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Abstract

Purpose: This meta-analysis aims to evaluate the efficacy of powered circular staplers (PCS) compared to manual circular staplers (MCS) in reducing anastomotic leakage (AL) and postoperative bleeding (AB) in colorectal surgery.

Methods: Extensive searches were performed in the Embase, PubMed, and SCOPUS electronic bibliographic databases. Most studies were of an observational nature, and only one randomized clinical trial was identified.

Results: Twelve studies met the inclusion criteria for anastomotic leakage and five for anastomotic hemorrhage. The number of patients included for AL analysis was 4524. The leakage rate was 4.6% (208 cases). The number of patients with AB was 2868 with a bleeding rate of 4.99% (143 patients). After identifying outliers and studies with possible selection bias, the odds ratio (OR) for leaks and PCS was 0.38 (95% CI 0.26-0.55), the relative risk was - 0.05 (95% CI - 0.07 to 0.03), and the number needed to treat to prevent one leak was 20. For bleeding, the PCS OR for PCS was 0.20 (95% CI 0.0772-0.5177).

Conclusion: Powered circular staplers could be associated with a significantly lower risk of leakage and anastomotic bleeding than two-row manual circular staplers. Further prospective randomized trials are needed to validate these findings.

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在结直肠手术中电动与手动圆形订书机的现有证据：系统回顾和荟萃分析。

目的：本荟萃分析旨在评价动力圆形吻合器（PCS）与手动圆形吻合器（MCS）在减少结直肠手术吻合口漏（AL）和术后出血（AB）方面的疗效。方法：在Embase、PubMed和SCOPUS电子书目数据库中进行广泛检索。大多数研究都是观察性的，只有一项随机临床试验被确定。结果：吻合口瘘纳入标准12项，吻合口出血纳入标准5项。纳入AL分析的患者数量为4524例。漏出率为4.6%（208例）。AB患者2868例，出血率4.99%（143例）。在确定异常值和可能存在选择偏差的研究后，泄漏和PCS的比值比（OR）为0.38 (95% CI 0.26-0.55)，相对风险为- 0.05 (95% CI - 0.07 - 0.03)，需要治疗以防止一次泄漏的数量为20。对于出血，PCS OR为0.20 （95% CI 0.0772-0.5177）。结论：动力环形吻合器与手动两排环形吻合器相比，其吻合口漏出血风险明显降低。需要进一步的前瞻性随机试验来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.