Intraoperative stapler misfire in gastrointestinal surgery: recognition, management, and prevention
DOI:
https://doi.org/10.18203/2349-2902.isj20252705Keywords:
Stapler misfire, Gastrointestinal surgery, Device malfunction, Powered staplers, Surgical safety, Simulation training, Medicolegal risk, Randomized trials, InnovationAbstract
Surgical staplers have revolutionized gastrointestinal surgery, offering precision, speed, and reduced blood loss. Yet, stapler misfires remain an under-recognized intraoperative hazard with the potential to cause devastating complications, including anastomotic leak, haemorrhage, and reoperation. Despite their clinical significance, these events are often underreported, inconsistently managed, and poorly understood by surgical teams. This review aims to provide a comprehensive overview of intraoperative stapler misfire in GI surgery. It covers etiopathogenesis, classification, clinical recognition, intraoperative salvage strategies, prevention through training and technology, and insights from contemporary randomized controlled trials and global device surveillance. A literature review was conducted using PubMed, Cochrane Library, and FDA databases for studies published between 2015 and 2025. Only peer-reviewed articles, systematic reviews, RCTs, and major adverse event reports related to GI stapling devices were included. Intraoperative stapler misfires result from a complex interplay of device mechanics, tissue characteristics, user technique, and environmental constraints. Powered staplers and smart sensing systems have reduced some risks, but human judgment and intraoperative vigilance remain the cornerstone of safety. Evidence suggests that misfires occur in up to 1.5% of GI stapler uses, with a significant proportion requiring conversion to hand-sewn techniques or leading to re-intervention. Surgeons must be equipped not only to operate advanced stapling devices but also to recognize and manage their failures promptly. Structured intraoperative algorithms, informed device selection, pre-emptive leak testing, and documentation are essential. This review provides the foundation for standardizing the surgical response to stapler misfires and advocates for transparency, training, and innovation in surgical safety.
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References
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