High incidence of technical errors involving the EEA circular stapler: a single institution experience

Background: The use of stapling devices is now widespread in colorectal resections. However, the incidence and clinical consequence of technical error involving the circular stapler are still poorly characterized.

Study design: We reviewed the operative reports and Web-based charts for all colon and rectal resections performed at our institution that used a circular stapler. Technical error was defined as any deviation from the normal technical performance of the circular stapler, including, but not limited to, surgeon misfiring, incomplete anastomosis (inadequate donuts or staple line defects), and primary device failure. The unpaired t- and chi-square tests were used for statistical analysis; p < 0.05.

Results: There were 349 colorectal resections performed and 67 (19%) featured a technical error. Thirty-two resections (9%) included an anastomotic error. The control group (n = 282) and the error group (n = 67) were comparable with regard to leaks, reoperation, suture line strictures, and hospital stay. The malfunction group had higher incidences of proximal diversions (34% versus 16%; p = 0.0003), ileus (24% versus 8%; p = 0.002), gastrointestinal bleeding (4% versus 0.4%; p = 0.023), and transfusion requirements (13% versus 4%; p = 0.004). Although proximal diversions in the error cohorts were also less likely to be planned (p < 0.001), reversal rates were similar in both groups (p = 0.28).

Conclusions: The incidence of technical error involving the circular stapler is considerable. Technical error was found to be associated with a significantly higher risk of gastrointestinal bleeding, transfusions, and unplanned proximal diversions.