Stapled anastomoses in colorectal surgery: a prospective study.
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.
Memon
A A
AA
Royal Surrey County Hospital, Guildford, UK
Marks
C G
CG
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*