title: Long-term results show triple stapling facilitates safe low colorectal and coloanal anastomosis and is associated with low rates of local recurrence after anterior resection for rectal cancer.
abstract: BACKGROUND
  During low anterior resection (AR), placement of a staple line distal to an occlusion clamp is often difficult due to the confines of a narrow bony pelvis. This study reviewed the results of AR with a technique in which a linear staple line is fired below the tumour as an oncologically safe occlusion clamp.
  
  
  METHODS
  Between 1995 and 2000, a total of 174 patients were operated for rectal cancer, and 153 of these patients had AR. Triple stapling (TS) was used to place a line of staples that occluded the fully mobilised rectum below a tumour. After rectal washout, a further linear stapler was applied below the first, and the rectum was divided prior to a standard circular stapled anastomosis.
  
  
  RESULTS
  TS was performed in 127 (83%) of 153 patients undergoing AR, and 9 TS patients developed leaks (7%). In the whole series of 174 cases, 9 patients had local recurrence (5%), but the local recurrence rate for procedures classified as 'locally curative' was 2%.
  
  
  CONCLUSIONS
  Triple stapling reliably occludes the rectum allowing for distal rectal washout. It eliminates clamp slippage and faecal spillage and improves access to the distal rectum for low anastomoses.
authors.affiliation: Colorectal Research Unit, North Hampshire Hospital, Basingstoke, UK. david.edwards@doctors.org.uk
authors.forename: D P
authors.initials: DP
authors.lastname: Edwards
authors.forename: R
authors.initials: R
authors.lastname: Sexton
authors.forename: R J
authors.initials: RJ
authors.lastname: Heald
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D017792:Surgical Stapling; D016896:Treatment Outcome