Which Stapler Charge Is Safest for Performing Ileocolic Anastomoses ?

Ileocolic anastomoses are made using a mechanical stapler or via hand-sewing, with many meta-analyses and reviews discussing their safety. This study compared two mechanical devices and charges, namely Echelon Flex with white charge (2.6 mm) versus EndoGIA with blue charge (3.5 mm), in isoperistaltic side-to-side ileocolic anastomosis after right hemicolectomy for cancer with similar surgical technique and postoperative management. Methods: We made a retrospective analysis of all right hemicolectomies for malignancies performed between 1 January 2014 and 31 December 2019 in our department, comparing the mechanical device and the stapler charge used for the ileocolic isoperistaltic anastomosis. Results: A total of 151 patients underwent right hemicolectomy for cancer. In 101 cases, the device used to perform ileocolic side-to-side isoperistaltic anastomosis was Echelon Flex with white charge (2.6 mm). In 50, the device used was EndoGIA with blue charge (3.5 mm). There were no significant differences in the baseline characteristics or complication rate (P=0.727). In particular, no differences were found in the rate of anastomotic leakage (P=0.851) or anastomotic bleeding (P=0.218). The median length of stay was ten and seven for the white and blue groups, respectively (P=0.112). Conclusion: In our experience, mechanical ileocolic anastomosis is safe, and the two indicated staplers with the described charges do not differ in terms of anastomotic leak or bleeding. We hope that this study will motivate further investigations in this field.