New alternative colorectal anastomotic devices: A systematic review and meta-analysis

Background: Colorectal anastomotic devices have been used for nearly a century, with stapled anastomoses being the most common despite leak rates up to 20 %. This review aimed to evaluate newer alternative devices. Method: A systematic review and meta-analysis of publications from the last decade were conducted, focusing on devices forming colorectal anastomoses, excluding those facilitating sutured or stapled anastomoses or designed to prevent leaks. Data from MEDLINE, Embase, Cochrane, and ClinicalTrials.gov were analysed. Results: Eighteen studies (7 human, 10 animal, 1 ex-vivo) involving 955 anastomoses were included. Compression mechanisms were the most common. The pooled complication rate in human studies was 9.7 % (95 % CI: 4.3-15.2 %) with significant heterogeneity (I2 = 81.7 %). The leak rate after compression anastomoses was 3.3 % (95 % CI: 1.9-4.7 %) with no heterogeneity (I2 = 0 %). A novel device with transanal catheters allowed intraoperative and postoperative assessment. Conclusions: Outcomes are comparable to existing methods, with new technologies offering promising advancements.