A new device for the treatment of coloproctostomic stricture after double stapling anastomoses.
OBJECTIVE
A new device of staple cutter was developed to evaluate the clinical effect for the treatment of rectal stricture after the double stapling anastomosis.


BACKGROUND
The double stapling technique has become an established reconstruction method for patients with low anterior resection. The major complication of anastomotic stricture associated with circular stapling has been reported to be harmful and distressing. Because underlying mechanisms of stricture are not well understood, no prophylactic means have been developed and this results in postoperative dilation still being the only treatment available. Although various dilation methods are used for the treatment of stricture, none is fully satisfactory.


METHODS
Low anterior resection was performed in 30 patients with rectal carcinoma using a double stapling technique. First, the incidence of the anastomotic stricture and the clinical factors that contribute to the stricture formation were studied. Second, the clinical effects and advantages of the treatment of coloproctostomic stricture using the newly developed device (staple cutter) were evaluated.


RESULTS
Nine (30%) of 30 patients had anastomotic stricture with the symptom of distressing frequent bowel movement. There was no significant relation between the clinical factors and the stricture when compared with that of nonstricture patients. Excellent dilation was performed in all of the nine strictures using the staple cutter, and the symptom of stricture disappeared dramatically in eight patients (89%) within 1 week. The recurrence of stricture occurred in two patients; however, it has not been observed after one further use of this treatment. The staple cutter is safe and easy to use even at the bedside, and except for a conventional anoscope, no special equipment, including fluoroscope, was needed.


CONCLUSIONS
From the significant effects and advantages, the procedure using staple cutter is recommended highly for the treatment of circular stapling anastomotic stricture of the rectum.
Department of Surgery II, Kumamoto University Medical School, Japan.
S
S
Shimada
M
M
Matsuda
K
K
Uno
H
H
Matsuzaki
S
S
Murakami
M
M
Ogawa
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003125:Colostomy; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000009:adverse effects* / Q000295:instrumentation*