A comprehensive review of the types and management of stapling failures in colorectal surgery.

Abstract

Although surgical staplers have significantly advanced the performance of colorectal surgery, stapling failures can compromise surgical outcomes. Understanding the mechanism of these complications and their management is crucial for improving patient safety. This review aims to provide a succinct summary of the existing literature on types and management of stapling failures. A comprehensive literature review of PubMed and Scopus databases through February 2025 was conducted to identify studies that reported types, mechanisms, detection methods, and management of stapling failures in colorectal surgery. Various types of surgical staplers used in colorectal surgery, including circular and linear staplers for open and laparoscopic procedures, were considered. The incidence of stapling failures in colorectal surgery ranges from 0.02% to 2.3%. Stapling failures encompass a range of mechanical failures and technical errors. Mechanical failures include misfires, jamming, and lockups. Technical failures include misalignment, crossing staple lines, improper selection, and poor technique. Risk factors include patient-related factors such as obesity and diabetes, and surgical factors such as pelvic surgery, emergency procedures, and inadequate rectal mobilization. The consequences of stapling failures include anastomotic leaks, strictures, and bleeding. Systematic detection methods such as the Wexner quadruple assessment help detect stapling misadventures. Management depends on the nature of the complication and intraoperative troubleshooting, and includes reinforcement sutures, anastomotic revision, and fecal diversion. Surgeons must be well-versed in preventing and addressing stapling failures to optimize patient outcomes. Recognizing risk factors, implementing systematic intraoperative assessments, and applying appropriate management strategies are critical to improving surgical outcomes.