End‐to‐end versus end‐to‐side stapled anastomoses after anterior resection for rectal cancer

Abstract

Regarding postoperative surgical complications, end-to-side anastomosis is a safe procedure.

Systematic Review of the Technique of Colorectal Anastomosis

“…Only 2 experimental studies matched the inclusion criteria; one study 117 found no significant difference in blood flow between ETE or side-to-side anastomosis after rectal resection in pigs, and the other 118 found better blood flow in ETE compared with side-to-end anastomosis after rectal resection in dogs. The included RCTs are also scarce: one 119 on ETE vs endto-side found more AL in ETE, and the other 120 on the optimum side limb for side-to-end colorectal anastomosis found no significant difference between 3-and 6-cm sized limbs. No studies investigating the ideal length of the enterotomy were identified.…”

A novel single-stapling technique for colorectal anastomosis: a pre-ligation single-stapling technique (L-SST) in a porcine model

“…L-SST and DST are almost the same anastomoses performed with a circular stapler, except for the dog ear; therefore, this result was reasonable. However, the dog ear and crossing point were previously reported to be potentially vulnerable areas and could also lead to anastomotic leakage [8][9][10]. Furthermore, multiple staplers firing during DST could lead to an excessively long stapling line due to an inadequate cutting angle in many cases, which might contribute to anastomotic leakage [11,12].…”

“…However, DST has some drawbacks such as the lateral intersecting staple lines (the so-called dog ears), crossing point of the staplers, and multiple staplers firing. The dog ear, crossing point, and multiple staplers firing might lead to anastomotic leakage [8][9][10][11][12]. In addition, laparoscopic surgery, especially an intracorporeal operation, is technically more difficult than open surgery due to the width and limited articulation of the devices.…”

Anastomotic Leak and Local Recurrence in Colorectal Cancer

“…9,10 The most important surgical complication following rectal resection with anastomosis is symptomatic AL. [3][4][5]11,12 The incidence of AL varies widely depending on the anastomosis type and the distance from the anal verge. Multiple studies have identified distance from the anal verge to be a substantial risk factor contributing to anastomotic breakdown.…”