title: [Modification and efficacy observation of laparoscopic dual anastomosis for mid-low rectal cancer].
abstract: OBJECTIVE
  To explore a new procedure of laparoscopic dual anastomosis for mid-low rectal cancer to reduce postoperative complications.
  
  
  METHODS
  Clinical data of 56 patients with mid-low rectal cancer undergoing laparoscopic rectal cancer resection(modified double-stapling technique, MDST, modification group) in the Department of General Surgery, the First Affiliated Hospital of Soochow University from February 2010 to June 2014 were compared with the data of 64 patients with mid-low rectal cancer (conventional double-stapling technique, DST, convention group) in the same period based on gender, age, tumor size, the distance from lower edge to the dentate line and tumor staging, etc. Patients in the modification group received operation as follows: (1) the rectum distal end was closed vertically instead of horizontally. (2) the anastomosis was conducted in an "end-corner" approach. (3) upper corner of the closed line in the distal end of rectum was removed. (4) the lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method. (5) two T-shaped interchanges ("dangerous triangle") of stapled sutures formed after anastomosis were strengthened with absorbable suture. Patients in the convention group received laparoscopic dual anastomosis using conventional method: two corners and "dangerous triangles" were kept without any treatment. The clinical outcomes of two groups were analyzed retrospectively.
  
  
  RESULTS
  The intraoperational blood loss, postoperative drainage volume, postoperative anastomotic stoma bleeding, bowel function return and hospital stay were not significantly different between the two groups (all P>0.05). As compared to the convention group, the modification group had longer operation time [(211 ± 91) min vs. (174 ± 57) min, P<0.05], lower incidence of postoperative anastomotic leakage [1.8%(1/56) vs. 12.5% (8/64), P=0.030], lower tenesmus rate [3.6% (2/56) vs. 14.1% (9/64), P<0.05], less postoperative stoma re-creation [0 vs. 9.4% (6/64), P<0.05].
  
  
  CONCLUSIONS
  Modified laparoscopic dual anastomosis for mid-low rectal cancer can significantly reduce the incidence of post-surgical complications such as anastomotic leakage.
authors.affiliation: Department of Surgery, The First People's Hospital of Wujiang District, Suzhou 215000, China. chenshaojidoctor@sohu.com.
authors.forename: Shaoji
authors.initials: S
authors.lastname: Chen
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Wu
authors.forename: Shanliang
authors.initials: S
authors.lastname: Han
authors.forename: Qinliang
authors.initials: Q
authors.lastname: Mo
authors.forename: Yuanming
authors.initials: Y
authors.lastname: Ma
authors.forename: Shiduo
authors.initials: S
authors.lastname: Song
authors.forename: Hong
authors.initials: H
authors.lastname: Zhao
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D006801:Humans; D010535:Laparoscopy; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies