title: Morbidity and mortality after single- and double-stapled colorectal anastomoses in patients with carcinoma of the rectum.
abstract: BACKGROUND
  The optimal method of restoring intestinal continuity after rectal resection has been controversial. This study aims to compare the morbidity, mortality and survival of patients having either single-stapled (SS) or double-stapled (DS) colorectal anastomoses following resection of the rectum for cancer.
  
  
  METHODS
  Peri-operative and long-term follow-up data were prospectively documented in all patients undergoing rectal resection for carcinoma with a stapled anastomosis at our institution over a 14-year period. Patients were stratified by anastomotic technique (SS or DS). Peri-operative mortality, complications potentially related to anastomotic technique and cancer-related outcome were compared.
  
  
  RESULTS
  Two hundred and thirty-five patients had SS and 65 patients had DS anastomoses. The groups were well matched for age, sex, and tumour stage. Double-stapled anastomoses were used more frequently in the distal third of the rectum (P < 0.001). The distal margin of resection was not influenced by anastomotic technique. Major anastomotic leakage in 2.9% of SS cases was not significantly different from 6.1% of DS cases, and leakage was not influenced by anastomotic technique at any given level of the rectum. Two-year local recurrence rates were not significantly different between groups (SS 3.5%; DS 5.9%).
  
  
  CONCLUSIONS
  These results suggest that the double-stapling technique is as safe as the single-stapling technique for constructing an anastomosis after excision of the rectum for cancer, in terms of the risk of leakage, the development of an anastomotic stricture, or local recurrence.
authors.affiliation: Department of Colon and Rectal Surgery, Concord Repatriation General Hospital, New South Wales, Australia.
authors.forename: J W
authors.initials: JW
authors.lastname: Moore
authors.forename: P H
authors.initials: PH
authors.lastname: Chapuis
authors.forename: E L
authors.initials: EL
authors.lastname: Bokey
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009517:New South Wales / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*