Safety of double-stapled anastomosis in low anterior resection

Abstract

Clinical leakage of the anastomosis follows low anterior resection for rectal carcinoma in 5-10 per cent of patients despite standard stapling techniques. A modification of this method has obviated the need for a distal purse string. A flexible transverse stapling instrument (Roticulator 55) is applied across the rectum below the tumour, and a double-staggered row of staples is inserted as a substitute for the distal purse string. End-to-end stapled anastomosis is then performed with peranal insertion of a Premium CEEA stapling instrument. In 111 patients the indications for operation were colorectal carcinoma (96 patients), diverticulosis (ten), megarectum (four) and ulcerative proctocolitis (one). Three patients had clinical evidence of anastomotic leakage; all survived. The incidence of radiological leakage on Gastrografin enema 10-12 days after operation was 9 per cent. The perioperative mortality rate was 2 per cent; all deaths were from cardiovascular causes. Local recurrence of tumour occurred in eight patients (7 per cent) after a mean follow-up of 40 months. In conclusion, double-stapled end-to-end anastomosis has made low anterior resection for rectal carcinoma a safe procedure with a low mortality rate, an acceptable local recurrence rate and minimal (clinical) anastomotic leakage.

Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy: A retrospective case-series study

“…Additionally, there was no local recurrence during the 26.8-mo follow-up period, although the long-term survival rate is unknown. This double stapling technique was first introduced in colorectal surgery (particularly rectal cancer) for use in a narrow operative field, and its safety in colorectal surgery has already been reported and demonstrated in many studies [26][27][28][29] . Thus, the double stapling technique can be useful and time-saving for esophagojejunostomy after LTG, and recent studies have reported on its safety [23,30,31] .…”

Safety of modified double‐stapling end‐to‐end gastroduodenostomy in distal subtotal gastrectomy

“…After its initial introduction by Nance in 1979 [6], the doublestapling method has been repeatedly reported as a safe and effective procedure for lower anterior resections [16,17].…”

The measurement and monitoring of surgical adverse events

“…The clinical features that were frequently cited included: signs of localised or generalised peritonitis; faecal discharge from the wound and/or drain; abscess; purulent discharge from drain, wound or anus; and fever. Some studies defined a clinical anastomotic leak as that requiring re-operation, 258,259 while others accepted signs of leak without further surgery.…”

“…258 Some studies defined a clinical anastomotic leak as that requiring re-operation, 258,259 while others accepted signs of leak without further surgery. This was also true of the upper gastrointestinal and hepatopancreaticobiliary literature, where some authors accepted clinical features (e.g.…”