The Double Stapling Technique for Low Anterior Resection

Abstract

Since the introduction of the end-to-end anastomosis (EEA) stapler for rectal reconstruction, we have used a modification of the conventional technique in which the lower rectal segment is closed with the linear stapler (TA-55) and the anastomosis is performed using the EEA instrument across the linear staple line (double stapling technique). Our experience with this procedure includes stapled colorectal anastomoses in 75 patients and is the basis for the report. This review presents the details and advantages of the technique and the results. Complications include two patients with anastomotic leak (2.7%), and two with stenosis that required treatment (2.7%). Protective colostomy was not done in this series. There were no deaths. Our experience and that of others suggests that this modification of the EEA technique can allow a lower anastomosis in some patients, and that it can be done with greater safety and facility.

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

“…Initially, the circular stapler was only indicated for lower anterior resection and esophagojejunal anastomosis, which are very difficult to perform with hand-suturing techniques [6,16]. However, it has recently been used in virtually all kinds of gastrointestinal anastomoses, including gastroduodenostomy.…”

“…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].…”

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

“…Low anterior resection (LAR) is the standard operation for rectal cancer and allows an anastomosis to be created at a lower level, thereby preserving the anal sphincter [1] . Nonetheless, anastomotic leakage remains one the most significant complications after LAR.…”

Anastomotic integrity and function: Role of the colonic J-pouch

“…The concept of stapling was further advanced by Knight and Griffen [11] who, based upon early work by Ravitch and Steichen [18], clearly demonstrated that double stapling was as safe as single stapling, thus obviating the problem of placing purse strings low in the pelvis. Cohen [19] and Griffen et al [20] subsequently confirmed the safety of this approach.…”