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Session: ePoster Monitor 3-Quality and Cost 1

eP148 - Double Row Staple Technology versus Triple Row Staple Technology for Colorectal Surgery: A Systematic Review and Meta-Analysis

Sunday, June 2, 2024
8:48 AM – 8:53 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Tyler McKechnie, MD, MSc (he/him/his)

    Resident Physician
    McMaster University
    McMaster University
    Hamilton, ON, Canada

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • VS

    Victoria Shi, MA

    Medical Student
    McMaster University
    Waterloo, Ontario, Canada

    Disclosure information not submitted.

  • EH

    Elena Huang, HBSc

    Medical Student
    McMaster University
    Kitchener, Ontario, Canada

    Disclosure information not submitted.

  • BH

    Bright Huo, MD

    General Surgery Resident
    McMaster University
    Hamilton, Ontario, Canada

    Disclosure information not submitted.

  • AD

    Aristithes Doumouras, MD, MPH

    Assistant Professor
    McMaster University
    Hamilton, Ontario, Canada

    Disclosure information not submitted.

  • NA

    Nalin Amin, MD, FRCS(C)

    Associate Professor
    McMaster University
    Ancaster, Ontario, Canada

    Disclosure information not submitted.

  • CE

    Cagla Eskicioglu, MD, Msc, FRCSC

    Associate Professor, Colon & Rectal Surgeon
    Faculty of Health Sciences, McMaster University
    Hamilton, Ontario, Canada

    Disclosure information not submitted.

    • Senior Author(s)

  • DH

    Dennis Hong, MD, M.S.c, FRCSC, FACS

    Associate Professor
    McMaster University
    Hamilton, Ontario, Canada

    Disclosure information not submitted.

Purpose/Background: Tri-Staple™ technology is a proprietary technology developed by Medtronic that was designed to address the shortcomings of double-staple technology. Some in vitro as well in vivo observational data have also suggested that anastomotic leak may be reduced with Tri-Staple™ technology compared to double staple-technology. We aimed to investigate this further by performing a systematic review and meta-analysis comparing double and triple row staple technology for gastrointestinal anastomoses in terms of intraoperative and short-term postoperative outcomes for colorectal surgery.Methods/Interventions: This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search in MEDLINE, Embase, and CENTRAL from database inception to September 2023 was performed. Articles were eligible for inclusion if they were randomized controlled trials or observational cohort studies comparing double row staple and triple row staple technology for colorectal surgery. The main outcomes included anastomotic leak, anastomotic hemorrhage, anastomotic stenosis, surgical site infection (SSI), and reoperation. A pair-wise meta-analysis was performed using an inverse variance random effects model. Risk of bias was assessed with Cochrane risk of bias tools. The GRADE approach was conducted to assess quality of evidence.Results/Outcomes: After reviewing 327 relevant citations, five retrospective cohort studies met inclusion criteria. Overall, 705 patients (mean age: 65.4+/-11.7, 39.5% female) had colorectal anastomoses fashioned with double row staple technology and 574 patients (mean age: 64.1+/-12.4, 46.0% female) with triple row staple technology. Most operations in both groups were low anterior resections with end-to-end anastomosis (double row: 67.5%; triple row: 66.9%). Fifty three percent and 45.2% had proximal diversion in the double row and triple row staple technology groups, respectively. Across all five included studies, the risk of anastomotic leak was significantly reduced with triple row staple technology (2% vs. 7%, RR 0.34, 95%CI 0.19-0.62, p < 0.01, I2=0%). There were no significant differences in anastomotic hemorrhage (RR 0.71, 95%CI 0.28-2.79, p=0.46, I2=0%), SSI (two studies, RR 0.52, 95%CI 0.18-1.51, p=0.23, I2=0%), or reoperation (three studies, RR 0.66, 95%CI 0.22-1.92, p=0.44, I2=67%) between groups. There were insufficient data to compare the groups in terms of anastomotic stenosis. Risk of bias was moderate for all included studies. GRADE certainty of evidence was low for anastomotic leak and very low for all other outcomes.Conclusion/

Discussion: Triple row staple technology may be superior to double row staple technology for end-to-end anastomosis in colorectal surgery, specifically through reduction in risk of anastomotic leak, according to low-to-very low certainty evidence. Future, large clinical trials are required to further investigate these findings.