Concept Design and Simulation Study on a “Phantom” Anvil for Circular Stapler

Rulli, F; Kartheuser, Alex; Amirhassankhani, Sasan; Mourad, Michel; Stefani, Mario; Aureli, Andrés de Ferrá; Sileri, Pierpaolo; Valentini, P

doi:10.1097/sle.0000000000000113

Cited by 2 publications

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“…In the high anastomosis, introduction and advancement of a circular stapler along the upper rectum can be technically challenging, particularly when the bowel is spastic. Forcible insertion potentially causes partial or full-thickness rectal injuries in the worst-case scenario 5 ; using smaller circular staplers could avoid such difficulties. Surgeons might be afraid of the risk of anastomotic strictures despite the lack of the objective data and consequently miss the potential benefits of using smaller circular staplers.…”

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Safety of Small Circular Staplers in Double Stapling Technique Anastomosis for Sigmoid Colon and Rectal Cancer

Nagaoka

Yamaguchi

Nagasaki

et al. 2021

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Although smaller circular staplers are easier to insert and less likely to involve the vagina and levator ani muscles when performing double stapling technique anastomosis, surgeons often consider that larger circular staplers would be safer in reducing the risk of postoperative anastomotic strictures. OBJECTIVE: This study aimed to investigate the safety of using 25-mm circular staplers compared with 28/29-mm staplers in the double stapling technique anastomosis regarding the development of anastomotic strictures and other complications. DESIGN: This is a retrospective observational study. SETTING: This study was conducted at a single comprehensive cancer center. PATIENTS: Consecutive patients undergoing curative colorectal resection with double stapling technique anastomosis for stage I to III sigmoid colon and rectal cancer between 2013 and 2016 were included. MAIN OUTCOME MEASURES: The incidence of anastomotic complications (strictures, leakage, and bleeding) was compared between the 25- and 28/29-mm circular staplers. Predictors for anastomotic strictures were investigated with multivariable logistic regression. RESULTS: Small (25-mm) staplers were used in 186 (22.8%) of 815 eligible patients. The 25-mm staplers were associated with use in female patients, splenic flexure take down, high tie of the inferior mesenteric artery, and low anastomosis. Overall anastomotic complications (11.8% vs 13.7%, p = 0.51), strictures (5.9% vs 3.3%, p = 0.11), leakage (2.7% vs 3.8%, p = 0.47), and bleeding (4.8% vs 7.6%, p = 0.19) were not different between the 25- and 28/29-mm staplers. From multivariable logistic regression, independent predictors of anastomotic strictures included diverting ostomy and anastomotic leakage, but not small circular stapler use. Most of the 32 anastomotic strictures were successfully treated without surgical intervention (finger dilation, n = 25; endoscopic intervention, n = 5). LIMITATIONS: This was a single-center retrospective study. CONCLUSIONS: Use of 25-mm circular staplers for double stapling technique anastomosis is safe and does not increase the risk of anastomotic strictures and other anastomotic complications in comparison with larger staplers. See Video Abstract at http://links.lww.com/DCR/B576. SEGURIDAD DE ENGRAPADORAS CIRCULARES PEQUEÑAS EN ANASTOMOSIS, CON TÉCNICA DE DOBLE ENGRAPADO PARA CÁNCER DE RECTO Y COLON SIGMOIDE ANTECEDENTES: Aunque las engrapadoras circulares más pequeñas son más fáciles de insertar y menos probable que involucren a la vagina y los músculos elevadores del ano, cuando se realiza una anastomosis con técnica de doble engrapado, frecuentemente los cirujanos consideran que las engrapadoras circulares más grandes, serían más seguras para disminuir los riesgos de estenosis anastomóticas postoperatorias. OBJETIVO: El estudio se dirigió para investigar la seguridad en el uso de engrapadoras circulares de 25 mm, en comparación con engrapadoras de 28/29 mm, en anastomosis con técnica de doble engrapado, en relación al desarrollo de estenosis anastomóticas y otras complicaciones. DISEÑO: Estudio observacional retrospectivo. AJUSTE: Centro oncológico integral único. PACIENTES: Se incluyeron pacientes consecutivos sometidos a resección colorrectal curativa, con anastomosis y técnica de doble engrapado, para cáncer de recto y colon sigmoide en estadios I-III entre 2013 y 2016. PRINCIPALES MEDIDAS DE RESULTADO: Se compararon las incidencias de complicaciones anastomóticas (estenosis, fugas y sangrados) entre las engrapadoras circulares de 25 y 28/29 mm. Los predictores para estenosis anastomóticas se investigaron con regresión logística multivariable. RESULTADOS: Entre un total de 815 pacientes elegibles, se utilizaron engrapadoras de 25 mm en 186 (22,8%). Las engrapadoras de 25 mm se asociaron con el uso en pacientes femeninas, descenso del ángulo esplénico, ligadura alta de arteria mesentérica inferior y anastomosis baja. Complicaciones anastomóticas generales (11,8% vs. 13,7%, p = 0,51), estenosis (5,9% vs. 3,3%, p = 0,11), fugas (2,7% vs. 3,8%, p = 0,47) y sangrado (4,8% vs. 7,6%, p = 0,19). No hubo diferencia entre las engrapadoras de 25 y 28/29 mm. En la regresión logística multivariable, predictores independientes de estenosis anastomóticas incluyeron ostomía derivativa y fuga anastomótica, pero no incluyeron el uso de engrapadoras circulares pequeñas. La mayoría de las 32 estenosis anastomóticas se trataron con éxito sin intervención quirúrgica (dilatación del dedo, n = 25; intervención endoscópica, n = 5). LIMITACIONES: Fue un estudio retrospectivo de un solo centro. CONCLUSIONES: El uso de engrapadoras circulares de 25 mm para la anastomosis con técnica de doble engrapado, es seguro y no aumenta el riesgo de estenosis anastomóticas y de otras complicaciones anastomóticas, cuando son comparadas con engrapadoras más grandes. Consulte Video Resumen en http://links.lww.com/DCR/B576. (Traducción—Dr. Fidel Ruiz-Healy)

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confidence: 99%

Safety of Small Circular Staplers in Double Stapling Technique Anastomosis for Sigmoid Colon and Rectal Cancer

Nagaoka

Yamaguchi

Nagasaki

et al. 2021

Diseases of the Colon &Amp; Rectum

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“…It is necessary to advance the circular stapler’s body and anvil into the bowel lumen before placing a circular staple. During this process, the width of the intestine, the height of the level of the anastomosis, and the size of the circular stapler are all factors that can result in bowel injury [ 4 , 5 ]. Therefore, it is necessary to use a circular stapler of an appropriate size.…”

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confidence: 99%

The effect of circular stapler size on anastomotic stricture formation in colorectal surgery: A propensity score matched study

Lee,

Park

et al. 2023

PLoS ONE

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Background Small circular staplers possess the advantage of being relatively easy to use when compared to larger circular staplers. However, there is some contention as to whether the use of small circular staples in colorectal surgery increases the incidence of anastomotic strictures. This study aimed to determine whether the frequency of anastomosis site stricture formation differs depending on stapler size when performing anastomosis in colorectal surgery. Methods Patients who underwent surgery for colon or rectal disease between June 1, 2009, and December 31, 2021, and who had circular staplers used for the formation of intestinal anastomoses post colectomy were included in our study. Propensity score matching with a 1:1 ratio using logistic regression was performed. The primary outcome was the anastomotic stricture rate, and the secondary outcome was total anastomotic complications. Results A total of 875 patients who were operated on by surgeons using 28/29-mm and 25-mm circular staplers were included. After propensity score matching, 106 patients were assigned to each group. Anastomotic strictures occurred in two cases (1.9%) from the 25-mm group and in four cases (3.8%) from the 28/29-mm group. There were no statistically significant differences between the two groups (p = 0.683). Anastomotic complications were observed in two cases (1.9%) from the 25-mm group and in six cases (5.7%) from the 28/29-mm group; no statistically significant differences were found (p = 0.280). Conclusion Circular stapler size does not influence anastomotic stricture formation in colorectal surgery.

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Concept Design and Simulation Study on a “Phantom” Anvil for Circular Stapler

Cited by 2 publications

References 10 publications

Safety of Small Circular Staplers in Double Stapling Technique Anastomosis for Sigmoid Colon and Rectal Cancer

Safety of Small Circular Staplers in Double Stapling Technique Anastomosis for Sigmoid Colon and Rectal Cancer

The effect of circular stapler size on anastomotic stricture formation in colorectal surgery: A propensity score matched study

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