ArticleSurgical endoscopy2017
Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate.
Article in Surgical endoscopy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06036862 (A Prospective Clinical Study of Transanal and Transabdominal Combined Endoscopic Resection of Rectal Stenosis and Anal Reconstruction for Severe Rectal Anastomotic Stenosis), which is not on this map. Cited by 47 papers, 8 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Prospective Clinical Study of Transanal and Transabdominal Combined Endoscopic Resection of Rectal Stenosis and Anal Reconstruction for Severe Rectal Anastomotic Stenosis
Who cites it
47 citing papers in PubMed, 8 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Single-stapling versus double-stapling technique for rectal anastomosis-meta-analysis.BJS open · 2026Pooled it
- The impact of the number of stapler firings on anastomotic leakage in minimally invasive rectal surgery: risk factor or technical marker of complexity? A systematic review, meta‑analysis, and metaregression.Techniques in coloproctology · 2026Pooled it
- Pooled it
- Meta-analysis of robotic-assisted NOSE versus traditional TWSR in colorectal cancer surgery: postoperative outcomes and efficacy.BMC surgery · 2024Pooled it
- The aortic calcification is a risk factor for colorectal anastomotic leakage.Updates in surgery · 2023Pooled it
- A meta-analysis of the role of diverting ileostomy after rectal cancer surgery.International journal of colorectal disease · 2021Pooled it
- The use of robotic or laparoscopic stapler in rectal cancer surgery: a systematic review and meta-analysis.Journal of robotic surgery · 2020Pooled it
- Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis.Techniques in coloproctology · 2020Pooled it
- Magnetic resonance imaging-based deep learning model to predict multiple firings in double-stapled colorectal anastomosis.World journal of gastroenterology · 2023Trial
- The application value of Da Vinci linear powered stapler SureForm in robotic sphincter-preserving surgery for rectal cancer: a prospective randomized clinical trial.Surgical endoscopy · 2026Article
- The Treatment Efficacy for Patients Undergoing Combined Transanal-Transabdominal Endoscopic Resection of Rectal Anastomosis Stenosis.Journal of surgical oncology · 2026Article
- Robotic Intracorporeal Single-Stapled Anastomosis (RiSSA): Indications, Technical Benefits, and Current Limitations.The international journal of medical robotics + computer assisted surgery : MRCAS · 2026Review
- Comparison of short-term outcomes among hand-sewn, stapled, and two-stage Turnbull-Cutait pull-through anastomoses in TaTME for low rectal cancer.Techniques in coloproctology · 2026Article
- Robotic Intracorporeal Single-Stapled Anastomosis (RISS) is Associated with Lower Anastomotic Leakage Rates than the Double-Stapled Technique After Minimally Invasive Total Mesorectal Excision for Rectal Cancer.Annals of surgical oncology · 2026Article
- Article
- Bow tie technique for single stapled colorectal anastomosis: observational cohort study.Surgical endoscopy · 2026Observational
- Prospective analysis of 246 fires of da Vinci SureForm SmartFire stapler in colorectal cancer: First Indian study.Journal of minimal access surgery · 2025Article
- Robotic intracorporeal single-stapling versus double-stapling anastomosis in left-sided colorectal cancer: a propensity score-weighted pilot study.Journal of robotic surgery · 2025Article
- A novel technique for low-rectal cancer: Pushing the anus in laparoscopic radical resection.Medicine · 2025Observational
- The Impact of Aortic Calcification on Surgical Outcomes in Colorectal Cancer Patients: A Retrospective Analysis Focused on Anastomotic Leakage.Medicina (Kaunas, Lithuania) · 2025Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnastomotic leakage following colorectal resection remains one of the most significant complications with relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the leak rate in double stapling anastomosis. However, there are no data concerning compression anastomosis. We present our institutional experience addressing this issue.
designThis is a retrospective review of a prospective institutional database of patients undergoing colonic and rectal resection for benign and malignant indications between January 2008 and December 2014 at the surgical department of the St. John of God Hospital, Vienna. Inclusion criteria were rectal division with linear stapling devices and construction of anastomosis to the rectal stump using a circular stapler or compression device.
resultsThree hundred eighty two (196 female; 51.3%) patients were included. Mean age was 65.8 years (range: 18-95) Indications for the operation included diverticular disease (44.8%), colorectal carcinoma (51.6%), inflammatory bowel disease (1.8%), and adenoma (1.8%). A laparoscopic approach was employed in 334 cases (87.4%); in 170 patients (44.9%), a compression anastomosis was created. One, two, and three or more stapler cartridges were used for rectal division in 58.4, 33.5, and 8.1%, respectively. Male gender, neoadjuvant therapy, rectal cancer as an underlying disease, laparoscopic surgical approach, and duration of operation longer than 200 min are leading causes for the usage of more than one stapler cartridge. Overall leak rate was 4.7% (18/382). The only factor associated with the occurrence of leakage was the use of three or more stapler cartridges for the closure of the rectal stump (p = 0.002).
conclusionOur data support that multiple stapler firings for rectal division following colorectal resection has a major impact on anastomotic leak rate. Especially in laparoscopic surgery efforts should be made to minimize the number of stapler cartridges used.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.