eP478 - Comparison of Anastomotic Complications Between Powered and Manual Circular Staplers for Left-sided Colorectal Anastomoses

Purpose/Background: Circular stapling devices for colorectal anastomosis, when compared to handsewn anastomosis, has been found to be safe and has resulted in decreased operative time. Low satisfaction rates with the use of manual circular staplers (MCS) however were reported as these resulted in technical errors when firing resulting in higher rates of anastomotic complications.Powered circular staplers (PCS) have been developed to address the limitations of traditional circular staplers. However, no local data exists comparing outcomes of cases when PCS are used in place of manual staplers. This study aims to determine whether the use of PCS will result in decreased anastomotic complications and improve surgeon satisfaction when using circular staplers.Methods/Interventions: A retrospective cohort study reviewed adult elective colorectal cases from 2021 to 2023 where circular staplers were used for colorectal anastomosis. The following data were retrieved: patient demographics, diagnosis, operation performed, type of circular stapler used, presence of protecting stoma, history of previous irradiation, early ( < 30 days after surgery) and late (> 30 days after surgery) anastomotic complications. Surgeons answered survey forms regarding their experience with PCS.Results/Outcomes: One hundred and ninety-six elective operations with colorectal anastomosis using circular staplers were performed from 2021 to 2023. Most cases were rectal cancers (87/196), followed by sigmoid cancers. Most were open procedures (58.16%). MCS were used in 140 cases, while 56 cases used PCS.Propensity score matching was performed, where 56 cases in each group were compared. There were no statistically significant differences in the early (p = 0.973) and late (p = 0.491) complication rates between the MCS and PCS groups (Table 1). Four intraoperative air leaks (IAL) were noted in the MCS group (7.14%) and none in the PCS group. Early postoperative anastomotic leak (EPAL) rates were 3.57% (2/56) in both the MCS and PCS groups. IAL and EPAL were managed with proximal bowel diversion, transanal suture reinforcement, or both. The following late anastomotic complications were observed: anastomotic stricture and rectovaginal fistula in the MCS group; and two cases of late anastomotic leaks in the PCS group managed with pelvic abscess drainage. Both groups had one mortality unrelated to anastomotic complications. More than 90% of responses to the questionnaire showed better overall experience and easier use of PCS.Conclusion/

Discussion: The use of surgical stapling devices has become commonplace in colorectal surgery. Operator experience, from literature, has been shown to be a factor for proper firing of staplers and the incidence rate of technical errors is 19% due to surgeon inexperience.The study demonstrated that PCS had comparable outcomes with MCS, with acceptable complication rates. IAL in the MCS group may be due to unnecessary movements and instability during firing. The presence of late anastomotic leaks in the PCS group are yet to be explained. Differences over grip strength of the users were also addressed by PCS. Feedback from the questionnaire showed preference for PCS mainly due to easier firing and higher confidence in the anastomosis. The long-term outcomes of the use of PCS, as well as its cost-effectiveness and impact on overall healthcare costs, have yet to be investigated locally.Table 1.Comparison of early and late anastomotic complications of colorectal anastomosis using manual and powered circular stapler devices. (PGH 2023). (PCS: Powered circular stapler; MCS: Manual circular stapler)