title: Modified double-stapling technique in low anterior resection for lower rectal carcinoma.
abstract: OBJECTIVE
  The original double-stapling technique (DST) using a standard linear stapler horizontally can be difficult in patients with a narrow pelvis or an ultralow anastomosis. We review our experience of performing a modified DST (IO-DST) with vertical division of the rectum achieved using an endostapler.
  
  
  METHODS
  We retrospectively studied the clinical outcomes of 90 patients who underwent low anterior resection (LAR) for lower rectal carcinoma. Low anterior resection was performed with IO-DST in 34 patients (IO-DST group), with the single-stapling technique (SST) in 47 (SST group), and with per anal anastomosis (PAA) in 9 (PAA group).
  
  
  RESULTS
  The distances from the anal verge to the tumor and to the anastomosis were significantly shorter in the IO-DST group than in the SST group (5.8 cm, 4.0 cm vs 7.0 cm, 5.0 cm, respectively), whereas it was equivalent in the IO-DST and PAA groups (5.0 cm, 4.0 cm). Blood loss was less in the IO-DST group than in the SST and PAA groups (400 ml vs 578 ml and 950 ml, respectively). The operative time was shorter in the IO-DST group than in the PAA group (281 min vs 327 min, respectively). There were no significant differences in the length of the distal surgical margin among the three groups. The IO-DST group patients suffered less bowel frequency than the SST group patients 1 month after surgery (2.5 times/day vs 4.0 times/day, respectively) and less than the PAA group patients more than 1 year after surgery (2.0 times/day vs 3.5 times/day, respectively). There were no significant differences in the incidence of complications or local recurrence among the three groups.
  
  
  CONCLUSIONS
  IO-DST is a feasible and safe procedure for performing low anastomosis, which results in less bowel frequency after LAR for lower rectal carcinoma.
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
authors.forename: Harunobu
authors.initials: H
authors.lastname: Sato
authors.forename: Koutarou
authors.initials: K
authors.lastname: Maeda
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Hanai
authors.forename: Masahisa
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Aoyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuoka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D003125:Colostomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome