Evidence map›Paper›PMID 41813999›Full record

SynthesisSurgical endoscopy2026

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

Nadeesha Samarasinghe, Wenjie Lin, Ahmer A Karimuddin, Carl J Brown, P Terry Phang, Manoj J Raval, Karen MacDonell, Amandeep Ghuman

Abstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Publisher
In one paragraph

Synthesis in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Nadeesha SamarasingheDivision of General Surgery, University of British Columbia, Room C313, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Wenjie LinDivision of General Surgery, University of British Columbia, Room C313, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Ahmer A KarimuddinDivision of General Surgery, University of British Columbia, Room C313, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Carl J BrownDivision of General Surgery, University of British Columbia, Room C313, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
P Terry PhangDivision of General Surgery, University of British Columbia, Room C313, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Manoj J RavalDivision of General Surgery, University of British Columbia, Room C313, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Karen MacDonellCollege of Physicians and Surgeons of British Columbia, Vancouver, BC, Canada.
Amandeep GhumanDivision of General Surgery, University of British Columbia, Room C313, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. aghuman@providencehealth.bc.ca.ORCID http://orcid.org/0000-0001-9871-9061

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnastomotic 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).

methodsThis 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.

results109 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).

conclusionThe 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.

Indexed as

Anastomosis, SurgicalAnastomotic LeakColonRectumSurgical StaplersSurgical StaplingColorectal Surgical ProceduresHumansAnastomotic leak rateColorectal surgeryEchelon powered staplerManual circular staplerPowered circular stapler

Identifiers

PMID41813999

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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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.