Saturday, July 13, 2024

Triple-Row Staple Technology May Reduce Anastomotic Leak in Colorectal Surgery

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Recent technological advancements in surgical procedures have led to the development of triple-row staple technology, which is now being evaluated for its effectiveness in reducing the incidence of anastomotic leaks in colorectal surgeries. This systematic review delves into comparing the efficiency of double-row staple technology with the newer triple-row staple technology, offering insights into their respective impacts on surgical outcomes.

Study Methodology

The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches were conducted in the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases up to November 2023. The review focused on studies comparing the two staple technologies for left-sided colo-colic, colorectal, or coloanal anastomoses. Key outcomes examined included anastomotic leaks, hemorrhage, 30-day mortality, and reoperation rates.

Six retrospective cohort studies, encompassing 19,372 patients with double-row staples and 2,298 patients with triple-row staples, were included in the analysis. The average age of participants was around 60 years, with a nearly balanced gender distribution. The majority of surgeries were anterior resections, with 55.3% conducted using double-row staples and 43.6% using triple-row staples.

Key Findings

The review found that the risk of anastomotic leaks was significantly lower with triple-row staple technology, showing a risk ratio of 0.54 and a 95% confidence interval of 0.31-0.94 (P = .03). However, no notable differences were observed between the technologies regarding anastomotic hemorrhage, 30-day mortality, or reoperation rates. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

Practical Implications

– Triple-row staple technology demonstrates a lower risk of anastomotic leaks.
– No significant difference in anastomotic hemorrhage between the two technologies.
– 30-day mortality rates are comparable between double and triple-row staples.
– Reoperation rates do not differ significantly between the two technologies.

This systematic review concludes that triple-row staple technology might offer a beneficial reduction in the risk of anastomotic leak in left-sided colorectal anastomoses, although it does not significantly impact other surgical complications such as hemorrhage, mortality, or reoperation rates.

Original Article: Surgery. 2024 Jun 13:S0039-6060(24)00296-4. doi: 10.1016/j.surg.2024.04.039. Online ahead of print. PMID: 38876899 | DOI: 10.1016/j.surg.2024.04.039

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