Association Between Cross-Stapling Technique in Mechanical Colorectal Anastomosis and Short-term Outcomes

Abstract

BACKGROUND: The double-stapled technique is the most common method of colorectal anastomosis in minimally invasive surgery. Several modifications to the conventional technique have been described to reduce the intersection between the stapled lines, as the resulting lateral dog-ears are considered possible risk factors for anastomotic leakage. OBJECTIVE: This study aimed to analyze the outcomes of patients receiving conventional versus modified stapled colorectal anastomosis after minimally invasive surgery. DATA SOURCES: A systematic review of the published literature was undertaken. PubMed/MEDLINE, Web of Science, and Embase databases were screened up to July 2023. STUDY SELECTION: Relevant articles were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles reporting on the outcomes of patients with modified stapled colorectal reconstruction compared with the conventional method of double-stapled anastomosis were included. INTERVENTIONS: Conventional double-stapling colorectal anastomosis and modified techniques with reduced intersection between the stapled lines were compared. MAIN OUTCOME MEASURES: The rate of anastomotic leak was the primary end point of interest. Perioperative details including postoperative morbidity were also appraised. RESULTS: There were 2537 patients from 12 studies included for data extraction, with no significant differences in age, BMI, or proportion of high ASA score between patients who had conventional versus modified techniques of reconstructions. The risk of anastomotic leak was 62% lower for the modified procedure than for the conventional procedure (OR = 0.38 [95% CI, 0.26–0.56]). The incidences of overall postoperative morbidity (OR = 0.57 [95% CI, 0.45–0.73]) and major morbidity (OR = 0.48 [95% CI, 0.32–0.72]) following modified stapled anastomosis were significantly lower than following conventional double-stapled anastomosis. LIMITATIONS: The retrospective nature of most included studies is a main limitation, essentially because of the lack of randomization and the risk of selection and detection bias. CONCLUSIONS: The available evidence supports the modification of the conventional double-stapled technique with the elimination of 1 of both dog-ears as it is associated with a lower incidence of anastomotic-related morbidity.