EEA stapler in low anterior anastomosis.
Preservation of the anal sphincter is a goal of all surgeons treating colorectal malignancies. In the hands of many, transsacral and low anterior resections with end-to-end anastomosis have been associated with high morbidity and leakage. The EEA stapler represents an alternative in re-establishing bowel continuity. Fifty-eight patients with adenocarcinoma of the rectum were treated over a three-year period at Roswell Park Memorial Institute. Forty-nine procedures judged to be curative and nine, palliative. All patients had an EEA stapler introduced through the anus. No protective colostomies were needed. No case of clinically significant anastomotic leakage was seen. Minor spotting or bleeding was documented, but no patient required blood transfusions. Two patients developed constipation; 16 patients had temporary soiling, two had prolonged soiling. Frank incontinence was not observed. The EEA stapler is an evolutionary instrument derived from the Russian PKS model. It is safe, reliable, and simple to operate. With adequate training of the surgeon, precious time can be saved. Intraoperative sigmoidoscopies, as well as postoperative barium enema examinations, were not needed. Gaps in the stapled anastomotic line (when present) were easily repaired. It is too early to tell whether anastomotic and local recurrence rates will increase, as more sphincter-saving procedures are performed. Five-year follow up is crucial to establish criteria for the use of the EEA stapler.
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D003082:Colectomy; D003106:Colon / Q000601:surgery; D003113:Colonoscopy; D003125:Colostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012812:Sigmoidoscopy; D013528:Surgical Staplers