Anastomotic leak rates between powered and non-powered circular staplers in left-sided colorectal resection; a retrospective cohort study

AIM: Anastomotic leak (AL) is associated with major post-operative morbidity and mortality. The circular stapler, widely utilised in colorectal anastomosis, has seen a technological change from manual firing stapler (MFS) to powered automated firing stapler (PAFS). PAFS may reduce user error and technique variation and may be associated with reduced AL rate. The primary aim of the study was to assess differences in AL rate between MFS and PAFS. Secondary aims were to assess differences in length of stay (LOS) and 30-day mortality. METHODS: This was a retrospective, single surgeon review of patients undergoing resection with anastomosis using a circular stapler between 2016 and 2023. A historical MFS group (n=105) and a study PAFS group (n=112) were identified. Demographics, comorbidity, operation type, neoadjuvant therapy, AL, LOS and 30-day mortality were recorded. RESULTS: The populations were comparable, with no significant difference in demographics, BMI, ASA grade, neoadjuvant radiotherapy use or type of operation. The PAFS group contained more non-malignant cases, 35% vs 18% (p=0.01). AL rate was 11.4% in the MFS group and 3.6% in the PAFS group (p=0.04). Fifty-eight percent of the anastomotic leaks in the MFS group needed surgery, compared to zero from the PAFS group (p=0.09). Mean LOS was 10 days in the MFS group and 6 days in the PAFS group (p = 0.01). Thirty-day mortality was 0.9% from the MFS group and zero from the PAFS group (p=0.48). CONCLUSION: While acknowledging confounders may have affected outcomes, in this study PAFS was safe and associated with a significant reduction in AL and LOS.