title: Laparoscopic colorectal anastomosis using the novel Chex(®) circular stapler: a case-control study.
abstract: OBJECTIVE
  The purpose of this study was to assess the safety and effectiveness of a new cost-effective circular stapler for colorectal anastomosis, the Chex(®) CS.
  
  
  METHODS
  From 2007 to 2009, a case-control study was conducted of 54 patients who underwent left colectomy with stapled anastomosis using the Chex stapler. The patients were matched to 64 patients in whom the anastomoses were performed using the CDH(®) stapler or the EEA(®) stapler. The following criteria were matched: sex, age, body mass index, American Society of Anesthesiology grade, diagnosis, formation of a temporary stoma and surgical approach. Primary end-points were postoperative mortality and morbidity. The surgeon was asked to fill out a questionnaire to assess the ergonomics of the device using an analogue visual scale. A cost analysis was performed to compare the cost of the different devices.
  
  
  RESULTS
  There were no postoperative deaths. Morbidity, including anastomotic leakage (9%vs 8%, P = 1.000), was similar in the two groups. The surgeon's overall appreciation was scored at 8.1/10 (3-9.5), including the best score for stapler removal (9.5). No major device failure was observed during the study. Mean surgical costs were significantly lower in the Chex group: € 903 ± 73 (885-1192) vs the control group € 971 ± 61 (956-1263) (P < 0.0001).
  
  
  CONCLUSIONS
  This study suggests that colorectal anastomosis using the Chex circular stapler is safe and does not increase overall morbidity. In particular, this device did not have a higher rate of anastomotic leakage in our patients than more expensive models currently used in our hospital.
authors.affiliation: Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital, AP-HP, Clichy, France.
authors.forename: L
authors.initials: L
authors.lastname: Maggiori
authors.forename: F
authors.initials: F
authors.lastname: Bretagnol
authors.forename: M
authors.initials: M
authors.lastname: Ferron
authors.forename: Y
authors.initials: Y
authors.lastname: Chevalier
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000295:instrumentation; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D001291:Attitude of Health Personnel; D016022:Case-Control Studies; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013528:Surgical Staplers / Q000009:adverse effects* / Q000191:economics; D055815:Young Adult