Colorectal anastomosis using a novel double-stapling technique for lower rectal carcinoma.
BACKGROUND
The conventional double-stapling technique (DST) using a standard linear stapler horizontally is sometimes difficult to apply to an anastomosis where the pelvis is narrow or the anastomosis is ultralow. In this report, we review our experiences of a novel DST (IO-DST) that employs vertical division of the rectum using an endostapler.


METHODS
One-hundred and five consecutive patients who underwent low anterior resection for rectal carcinoma below the peritoneal reflection were enrolled into this study. The clinical, oncological, and functional outcomes were studied retrospectively.


RESULTS
The median distance from the anal verge to the tumor was 5.0 cm in "high risk" T1 tumors and 6.5 cm in more-advanced tumors. More than 2 cm of distal surgical margin was obtained in 80.6% of the patients with tumors deeper than T1. The median distance from the anal verge to the anastomosis was 4.2 cm in T1 tumors and 4.0 cm in more-advanced tumors. The median blood loss was 315 ml, and the median operative time was 262 min. There was no mortality in the IO-DST. Recurrence presented in 12 (13.0%) of the patients who underwent curative surgery, with local recurrence in four patients (4.3%) during a median follow-up of 46.2 months. However, no patients experienced suture-line recurrence. The early bowel frequency was four times/day after stoma closure in patients with transient covering colostomy and 3.5 times/day in patients without colostomy. The late bowel frequency was three times/day in patients with transient covering colostomy, and two times/day in patients without colostomy.


CONCLUSIONS
The IO-DST is a feasible and safe procedure for facilitating lower anastomosis in rectal carcinoma below the peritoneal reflection.
Sato
Harunobu
H
Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. harsato@hotmail.com
Maeda
Koutarou
K
Hanai
Tsunekazu
T
Aoyama
Hiroyuki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*
Acta Chir Hung. 1994;34(1-2):139-49
7604617
World J Surg. 2004 Apr;28(4):416-9
15022022
Aust N Z J Surg. 1996 Dec;66(12):820-3
8996062
Br J Surg. 1983 Dec;70(12):727-9
6640254
Dis Colon Rectum. 1983 Apr;26(4):231-5
6839891
Surg Today. 2006;36(1):30-6
16378190
Br J Surg. 1992 Aug;79(8):836-8
1393488
Acta Chir Scand. 1986 Dec;152:743-7
3591203
Ann Surg. 2005 Oct;242(4):502-10; discussion 510-1
16192810
Dis Colon Rectum. 1997 Jan;40(1):117
9102254
Ann Surg. 1979 Jun;189(6):791-7
453950
Br J Surg. 1995 Aug;82(8):1049
7648149
Dis Colon Rectum. 1998 May;41(5):543-9; discussion 549-51
9593234
Surg Today. 1997;27(8):706-9
9306583
Dis Colon Rectum. 1995 Dec;38(12):1246-50
7497834
Dis Colon Rectum. 2002 Jul;45(7):934-9
12130883
Tech Coloproctol. 2003 Apr;7(1):29-33
12750952
Br J Surg. 1994 Jul;81(7):1057
7922064
Dis Colon Rectum. 2004 Oct;47(10):1706-10
15540303
Dis Colon Rectum. 1991 Jun;34(6):495-7
2036929
Surgery. 1980 Nov;88(5):710-4
7434211
Br J Surg. 1994 Aug;81(8):1230
7953371
Br J Surg. 1995 May;82(5):608-10
7613927
Surg Today. 2002;32(6):487-92
12107771
Aust N Z J Surg. 1997 Sep;67(9):607-10
9322696
World J Surg. 1992 Sep-Oct;16(5):866-71
1462621
Br J Surg. 1990 Aug;77(8):888-90
2393811