Circular staplers and anastomotic leakage in colorectal surgery: meta-analysis
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Résumé
BACKGROUND: Anastomotic leakage is a feared complication after colorectal resection. Recent advancements in surgical techniques, particularly the use of circular staplers, have aimed to improve postoperative outcomes. However, the optimal choice of circular stapler remains uncertain, with debate surrounding its impact on anastomotic leakage rates. The aim of this meta-analysis was to evaluate the impact of different circular stapler characteristics on anastomotic leakage occurrence after left colorectal resection. METHODS: A systematic review and meta-analysis using PubMed, Scopus, and Web of Science databases to identify studies on the correlation between circular staplers and anastomotic leakage occurrence were performed up to November 2023 (PROSPERO registration: CRD42024519036). The literature search was conducted according to the PRISMA guidelines and performed using the following search terms: 'colorectal surgery', 'staplers', 'complications'. Only retrospective, cohort, prospective and randomized clinical trials on anastomotic leakage rate after left colorectal resection, including adult patients (over 18 years of age) and published in English were included. Exclusion criteria were articles with different designs, and studies including extra-colonic or right/transverse colon diseases. The quality assessment of the study was performed using the Newcastle-Ottawa classification. The outcome of interest was the analysis of each staplers' characteristics including: diameter, number of rows, technology (manual versus powered) and anastomotic technique (single- versus double-stapling technique) on anastomotic leakage occurrence. RESULTS: Twenty-one retrospective studies were selected including 24 511 patients. A higher anastomotic leakage rate was documented for 31/33 mm stapler diameters compared with the 28/29 mm (OR -0.92, 95% c.i. -1.74 to -0.10; P = 0.02), while no significant difference was found between the 25 mm and 28/29 mm diameters (OR -0.46, 95% c.i. -1.39 to 0.46; P = 0.2). Similar anastomotic leakage rates were found for the two- and three-row circular stapler groups (OR -0.01, 95% c.i. -0.16 to 0.13; P = 0.85). Conversely, the powered technology related to a significantly lower rate of anastomotic leakage compared with the manual technology (OR -0.83, 95% c.i. -1.13 to -0.35; P < 0.001). Similarly, the single-stapling technique related to a lower rate of anastomotic leakage compared with the double-stapling technique (OR 0.79, 95% c.i. 0.33 to 1.25; P < 0.001). CONCLUSION: This study shows a higher anastomotic leakage rate for larger circular staplers and manual technology. Similarly, the single-stapling technique has advantages over the double-stapling technique, while the tri-staple technology does not appear to confer advantages on anastomotic leakage occurrence.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,010 | 0,003 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle