title: Trans-anal reinforcing sutures after double stapling for lower rectal cancer: report of two cases.
abstract: To safely avoid the construction of a covering stoma in patients with advanced lower rectal cancer undergoing laparoscopy assisted colorectal surgery (LACS), we added circumferential manual reinforcing sutures via the transanal approach at the site of mechanical anastomosis. In June 2008, LACS was performed for a tumor of 6 cm in longer diameter in the Rb region of the lower rectum approximately 5 cm from the anal verge. After intraperitoneal coloproctal anastomosis was performed in the pelvis by the double stapling technique (DST), reinforcement was provided by manual trans-anal suturing (trans-anal reinforcing sutures: TARS). A covering stoma was constructed because this was a high-risk case. Complications such as mild wound infection and stoma trouble occurred, and the patient was discharged after conservative therapy. In June 2008, LACS was performed for a tumor of 5 cm in longer diameter in the Ra region of the lower rectum approximately 7 cm from the anal verge. After intraperitoneal colorectal anastomosis was performed in the pelvis by DST, TARS were added to avoid a covering stoma. Minor leakage occurred postoperatively, but this was controlled conservatively and the patient was discharged. In patients having surgical treatment of advanced lower rectal cancer, good results were obtained by adding circumferential reinforcing sutures via the trans-anal approach at the site of ultra-low anastomosis after DST.
authors.affiliation: Department of Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan. mukai.masaya@hachioji-hosp.tokai.ac.jp
authors.forename: Masaya
authors.initials: M
authors.lastname: Mukai
authors.forename: Maki
authors.initials: M
authors.lastname: Fukasawa
authors.forename: Kyoko
authors.initials: K
authors.lastname: Kishima
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Iizuka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukumitsu
authors.forename: Naoki
authors.initials: N
authors.lastname: Yazawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tajima
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Makuuchi
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D001145:Arrhythmias, Cardiac / Q000150:complications; D003920:Diabetes Mellitus; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000150:complications; D017792:Surgical Stapling; D054047:Surgical Stomas; D013536:Suture Techniques