title: Colorectal anastomosis using a novel double-stapling technique for lower rectal carcinoma.
abstract: 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.
authors: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. harsato@hotmail.com
authors: Harunobu
authors: H
authors: Sato
authors: Koutarou
authors: K
authors: Maeda
authors: Tsunekazu
authors: T
authors: Hanai
authors: Hiroyuki
authors: H
authors: Aoyama
mesh_terms: 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*
references: Acta Chir Hung. 1994;34(1-2):139-49
references: 7604617
references: World J Surg. 2004 Apr;28(4):416-9
references: 15022022
references: Aust N Z J Surg. 1996 Dec;66(12):820-3
references: 8996062
references: Br J Surg. 1983 Dec;70(12):727-9
references: 6640254
references: Dis Colon Rectum. 1983 Apr;26(4):231-5
references: 6839891
references: Surg Today. 2006;36(1):30-6
references: 16378190
references: Br J Surg. 1992 Aug;79(8):836-8
references: 1393488
references: Acta Chir Scand. 1986 Dec;152:743-7
references: 3591203
references: Ann Surg. 2005 Oct;242(4):502-10; discussion 510-1
references: 16192810
references: Dis Colon Rectum. 1997 Jan;40(1):117
references: 9102254
references: Ann Surg. 1979 Jun;189(6):791-7
references: 453950
references: Br J Surg. 1995 Aug;82(8):1049
references: 7648149
references: Dis Colon Rectum. 1998 May;41(5):543-9; discussion 549-51
references: 9593234
references: Surg Today. 1997;27(8):706-9
references: 9306583
references: Dis Colon Rectum. 1995 Dec;38(12):1246-50
references: 7497834
references: Dis Colon Rectum. 2002 Jul;45(7):934-9
references: 12130883
references: Tech Coloproctol. 2003 Apr;7(1):29-33
references: 12750952
references: Br J Surg. 1994 Jul;81(7):1057
references: 7922064
references: Dis Colon Rectum. 2004 Oct;47(10):1706-10
references: 15540303
references: Dis Colon Rectum. 1991 Jun;34(6):495-7
references: 2036929
references: Surgery. 1980 Nov;88(5):710-4
references: 7434211
references: Br J Surg. 1994 Aug;81(8):1230
references: 7953371
references: Br J Surg. 1995 May;82(5):608-10
references: 7613927
references: Surg Today. 2002;32(6):487-92
references: 12107771
references: Aust N Z J Surg. 1997 Sep;67(9):607-10
references: 9322696
references: World J Surg. 1992 Sep-Oct;16(5):866-71
references: 1462621
references: Br J Surg. 1990 Aug;77(8):888-90
references: 2393811