Circular powered staplers versus manual staplers in left-sided colorectal anastomoses: a systematic review and meta-analysis.

Anastomotic leaks in colorectal surgery increase mortality, local cancer recurrence, and hospital readmission rate. The Echelon Circular Powered Stapler (PCS) is marketed to reduce anastomotic leaks by minimizing operator errors through powered systems. We reviewed current evidence on the use of PCS in left-sided colorectal anastomoses to determine if there is a reduction in anastomotic leak rates versus manual circular staplers (MCS). This study followed PRISMA guidelines. MEDLINE, EMBASE, CINAHL, and OVID review databases were searched to January 2024. A broad search strategy for PCS versus MCS in colorectal surgery was used. Abstracts were reviewed for the primary outcome of anastomotic leaks, and data were extracted from full-text review. Statistical analysis was performed using RevMan 5.4 software. 109 articles were screened, 9 studies with 3110 patients were included. No randomized control trials (RCTs) were found. In pooled and sensitivity analysis excluding studies that used historic comparators, there was no significant difference in the rates of anastomotic leak (pooled RR 0.56, 95% CI [0.27-1.18], p = 0.13; sensitivity analysis RR 0.75, 95% CI [0.32-1.77], p = 0.52). Similarly, there was no significant difference in morbidity between PCS and MCS on pooled analysis (RR 0.84, 95% [CI 0.65-1.08], p = 0.17). However, on pooled analysis, there was a significantly lower rate of post-operative bleeding with the use of PCS (RR 0.2, 95% CI [0.08-0.51], p < 0.001). The current systematic review and meta-analysis is unable to support the claim of lower leak rate with the use of PCS; however, there is preliminary evidence to indicate that powered staplers may decrease the rate of post-operative bleeding. Further evidence from RCTs investigating anastomotic leaks and bleeding rate with PCS and assessments of environmental impact should be conducted prior to the widespread use of powered staplers.