Sphincter-saving surgery for rectal and colorectal disorders.
BACKGROUND
Restoration of intestinal continuity by anal anastomosis after sphincter-saving rectal excision is feasible from an oncological, technical and functional standpoint. We present our experience.


METHODS
The records of 223 patients with an anal anastomosis were reviewed. The anal anastomosis was performed hand-sutured transanally in 92 patients and double-stapled transabdominally in 131 patients. Coloanal anastomosis was performed in 39 patients and ileoanal pouch anastomosis in 184 patients.


RESULTS
Operation time, blood loss and admission times were considerably less after double-stapling anastomosis. Relevant complications occurred in 15% after coloanal anastomosis and in 35% after ileoanal pouch anastomosis, failure rate was similar (13%). Complication (7% vs 43%) and failure rate (2% vs 27%) were less after double-stapled anastomosis. Prednisone did not influence the failure rate whereas previous abdominal surgery did.


CONCLUSIONS
The double-stapling technique gives less complications and better results although effects of a learning curve are undoubtedly present in this series. The technique makes a temporary diverting ileostomy superfluous. The double-stapling technique is to be preferred for anal anastomoses.
Van Tets
W F
WF
Dept. of Surgery of Groot Ziekengasthuis Den Bosch, University Hospital Nijmegen, St Jozef Ziekenhuis Veldhoven, The Netherlands.
Kuijpers
J H
JH
Mortelmans
L J
LJ
Van Goor
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D001005:Anus Neoplasms / Q000175:diagnosis / Q000601:surgery; D002648:Child; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*