title: Stapled anastomoses in colorectal surgery: a prospective study.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of stapled anastomosis in left sided colorectal reconstructions.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  District hospital, UK.
  
  
  METHODS
  218 Consecutive patients who underwent elective colorectal reconstructions with stapled anastomoses between July 1980 and July 1994.
  
  
  METHODS
  154 Anterior resections of the rectum using single or double stapled anastomoses, 37 rejoining after Hartmann's operations, and 28 restorative proctocolectomies with formation of J pouch ileoanal anastomoses.
  
  
  METHODS
  Morbidity and mortality.
  
  
  RESULTS
  There were 5/154 clinical anastomotic leaks after anterior resection of the rectum and 1/28 after stapled J pouch ileoanal anastomoses. There were no leaks after rejoining of Hartmann's. The overall clinical leak rate was therefore 3%. 11/154 tumours recurred locally after anterior resection of the rectum (7%) during a mean follow up of 18 months, and 8 (73%) developed within 2 years of operation. All but one recurrence developed after single stapled anastomosis. Dukes' staging remains the most reliable prognostic indicator of the local recurrence of the tumour. There were five postoperative deaths after anterior resection but none after Hartmann's procedure or J pouch ileoanal anastomosis, giving an overall postoperative mortality of 2.3%.
  
  
  CONCLUSIONS
  The use of stapling instruments in left sided colorectal anastomosis is safe and technically easy, with a low clinical anastomotic leak rate and an acceptable rate of local recurrence after anterior resection of the rectum.
authors.affiliation: Royal Surrey County Hospital, Guildford, UK
authors.forename: A A
authors.initials: AA
authors.lastname: Memon
authors.forename: C G
authors.initials: CG
authors.lastname: Marks
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*