title: Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy?
abstract: OBJECTIVE
  To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution.
  
  
  METHODS
  The data of patients who received trans-anal reinforcing sutures were compared with those of patients who did not receive them after low anterior resection. Patients who underwent laparoscopic low anterior resection and the double-stapled anastomosis technique for primary rectal cancer between January 2008 and December 2011 were included in this study. Patients with no anastomosis, a hand-sewn anastomosis, high anterior resection, or preoperative chemoradiation were excluded. The primary outcomes measured were the incidence of postoperative anastomotic complications and placement of a diverting ileostomy.
  
  
  RESULTS
  Among 110 patients, the rate of placement of a diverting ileostomy was significantly lower in the suture group (SG) compared with the non-suture control group (CG) [SG, n = 6 (12.8%); CG, n = 19 (30.2%), P = 0.031]. No significant difference was observed in the rate of anastomotic leakage [SG, n = 3 (6.4%); CG, n = 5 (7.9%)].
  
  
  CONCLUSIONS
  Trans-anal reinforcing sutures may reduce the need for diverting ileostomy. A randomized prospective study with a larger population should be performed in the future to demonstrate the efficacy of trans-anal reinforcing sutures.
authors: Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea.
authors: Se-Jin
authors: SJ
authors: Baek
authors: Jin
authors: J
authors: Kim
authors: Jungmyun
authors: J
authors: Kwak
authors: Seon-Hahn
authors: SH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D057868:Anastomotic Leak / Q000209:etiology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Anastomotic leak; Double-stapled anastomotic technique; Low anterior resection; Rectal neoplasms; Reinforcement sutures
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