title: Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection.
abstract: BACKGROUND
  We experienced some technical difficulty in dividing the middle and lower rectum through the right-lower quadrant intracorporeally. The aim of this study was to determine whether multiple stapler firings during rectal division are associated with anastomotic leakage after laparoscopic rectal resection.
  
  
  METHODS
  Laparoscopic anterior resection with double-stapling technique anastomosis was performed in 180 consecutive rectal cancer patients. We often used vertical rectal division through a suprapubic site instead of the standard transverse rectal division for laparoscopic total mesorectal excision (LapTME). We attempted to determine whether there was an association between the number of stapler firings and procedures in rectal division. Moreover, we identified risk factors for anastomotic leakage after laparoscopic rectal resection by multivariate analysis.
  
  
  RESULTS
  Anastomotic leakage occurred in 5% of the subjects of this study. Vertical rectal division through the suprapubic site after Lap TME required fewer staples than transverse division through the right-lower port and a smaller percentage of patients required three or more staples for vertical rectal division than for transverse division (15% vs. 45%, p=0.03). In the multivariate analysis, TME and the number of staplers used for rectal division were the factors found to be associated with a significantly greater risk of subsequent leakage (odd's ratio=5.3; 95% CI 1.2-22.7 and odd's ratio=4.6; 95% CI 1.1-19.2).
  
  
  CONCLUSIONS
  TME and multiple stapler firings during distal rectal division were associated with anastomotic leakage after laparoscopic rectal resection. Vertical rectal division through a suprapubic site was a useful method of avoiding multiple stapler firings during laparoscopic TME.
authors: Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. maito@east.ncc.go.jp
authors: Masaaki
authors: M
authors: Ito
authors: Masanori
authors: M
authors: Sugito
authors: Akihiro
authors: A
authors: Kobayashi
authors: Yusuke
authors: Y
authors: Nishizawa
authors: Yoshiyuki
authors: Y
authors: Tsunoda
authors: Norio
authors: N
authors: Saito
mesh_terms: D000714:Anastomosis, Surgical; D006801:Humans; D010535:Laparoscopy; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects*