title: Feasibility and impact on surgical outcomes of modified double-stapling technique for patients undergoing laparoscopic anterior resection.
abstract: BACKGROUND
  Anastomotic leakage is a major cause of postoperative morbidity and mortality in the treatment of colorectal cancer. The aim of this study was to investigate the modified double-stapling technique (MDST), as an alternative for conventional double-stapling technique (DST), and whether it could reduce the anastomotic leakage rate in laparoscopic anterior resection (Lapa-AR).
  
  
  METHODS
  Between March 2009 and October 2010, a total of 189 patients who underwent Lapa-AR for the treatment of adenocarcinoma of the sigmoid colon or rectosigmoid colon were divided into the MDST group (n = 95) and the DST group (n = 94) according to the anastomotic technique. Data were analyzed retrospectively. Morbidity and anastomotic leakage rate were compared between the two groups.
  
  
  RESULTS
  Patient demographics, preoperative comorbidity, tumor size, stage, and operative details were comparable between the two groups. There was no difference in operation time between the two groups. The overall complication rate was significantly lower in the MDST group than in the DST group (3.2 vs. 10.6 %, p = 0.042), including anastomotic leakage rate (0 vs.4.6 %, p = 0.029). The anastomotic technique was the only factor associated with anastomotic leakage in univariate analysis.
  
  
  CONCLUSIONS
  Our comparative study demonstrates MDST to have better short-term outcome in reducing anastomotic leakage compared with DST. This technique could be an alternative approach to maximize the patients' benefit in laparoscopic anterior resection.
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, South Korea.
authors.forename: Jeonghyun
authors.initials: J
authors.lastname: Kang
authors.forename: Han Beom
authors.initials: HB
authors.lastname: Lee
authors.forename: Jang Ho
authors.initials: JH
authors.lastname: Cha
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: Seung Kook
authors.initials: SK
authors.lastname: Sohn
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
mesh_terms: D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome