title: Long-term Evaluation of a Modified Double Staple Technique for Low Anterior Resection.
abstract: BACKGROUND
  When performing low anterior resection for rectal cancer with the double staple technique, -closing the rectum with a linear stapler in the abdomen can be challenging, especially when dealing with a narrow pelvis. For such instances we proposed to modify this technique by pulling the rectal stump through the anus, doing an extra-anal resection of the tumor and linear suture of the rectal stump, before performing a standard, stapled colorectal anastomosis. The purpose of this study was to assess the adequacy of this modification of the double staple technique.
  
  
  METHODS
  Retrospective review of 108 patients undergoing a stapled, low colorectal or coloanal anastomosis, after -eversion, extra-anal resection of the tumor and linear closure of the rectal stump for colorectal cancer, from January 1990 to December 2012.
  
  
  RESULTS
  Operative mortality was 0.9%. Fourteen patients (13%) presented early, surgery-related complications -consisting of 7 anastomotic leaks, 5 wound infections, 1 ureteral lesion, and 1 peristomal abscess. Late complications related to surgery included 5 incisional hernias (4.6%), 4 anastomotic strictures (3.7%), 4 neurogenic bladders (3.7%) and 2 fecal incontinences (1.8%). The incidence of local disease recurrence was 10%.
  
  
  CONCLUSIONS
  Surgical and oncological results validate the proposed modification of the double staple technique, when facing difficulties in suturing the rectum from the abdomen.
authors.affiliation: The "F. Durante" Department of Surgery, the University of Rome "La Sapienza", Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Illuminati
authors.forename: F
authors.initials: F
authors.lastname: Carboni
authors.forename: G
authors.initials: G
authors.lastname: Ceccanei
authors.forename: M A
authors.initials: MA
authors.lastname: Pacilè
authors.forename: G
authors.initials: G
authors.lastname: Pizzardi
authors.forename: P
authors.initials: P
authors.lastname: Palumbo
authors.forename: F
authors.initials: F
authors.lastname: Vietri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors