title: Feasibility of end-to-anterior wall anastomosis in conversion of the double-stapling technique during laparoscopically assisted surgery.
abstract: BACKGROUND
  Double stapling technique (DST) is a physiological end-to-end anastomosis that is currently used widely in rectal surgery and also in sigmoidectomy. In laparoscopy-assisted sigmoidectomy, we occasionally encounter obstruction during insertion of the circular stapler device from the anus. In such cases, we used to cut the residual rectosigmoid colon additionally and to allow DST anastomosis. Here, we propose an alternative way to overcome this difficulty, that is to perform an anastomosis to the anterior wall of the rectosigmoid colon.
  
  
  METHODS
  Between 2001 and 2007, we experienced the cases of 10 sigmoid colon cancer patients who underwent laparoscopic surgeries with a conversion from DST to end to side (anterior wall) anastomosis.
  
  
  RESULTS
  None of the patients suffered from anastomosis leakage, and none had complained of their stool habits. Colonoscopy showed that anastomosis window is kept wide and that stool is not pooled in the blind pocket of the rectosigmoid colon, suggesting the passage is well preserved.
  
  
  CONCLUSIONS
  Our experience indicates that though several technical points should be noted, an end to anterior wall anastomosis procedure is easy and safe. This method is a useful alternative way when end-to-end DST anastomosis is not performed smoothly in laparoscopic surgery.
authors.affiliation: Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan. hyamamoto@gesurg.med.osaka-u.ac.jp
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Norikatsu
authors.initials: N
authors.lastname: Miyoshi
authors.forename: Naotsugu
authors.initials: N
authors.lastname: Haraguchi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takemasa
authors.forename: Masaya
authors.initials: M
authors.lastname: Nomura
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Mizushima
authors.forename: Masataka
authors.initials: M
authors.lastname: Ikeda
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome