Abstract
The double stapling technique for rectal reconstruction after resection involves closing the lower rectal segment with a linear stapler and performing the anastomosis using a circular stapler across the linear staple row. The purpose of this report is to review the results of double stapling, present our experience, and draw conclusions from the material available. We have utilized the double stapling technique in 80 patients for primary anastomoses and in 11 patients for secondary anastomoses following Hartmann procedures. Twenty-one anastomoses were at or near the dentate line. Fifty-six patients had rectal carcinoma, 29 patients had diverticulitis, 3 patients had carcinoma of the ovary, and 1 patient each had traumatic rectal perforation, volvulus, or rectal prolapse. Complications in the total 91 patients included 3 anastomotic leaks (3.3%), 1 postoperative hemoperitoneum (1.1%), and 3 strictures (3.3%). No anastomosis was protected by diverting colostomy. There were no operative deaths. Of 43 patients with cancer available for follow-up, 4 patients have developed local recurrence. The technique has been modified for ileoanal anastomosis during abdominal restorative proctocolectomy for ulcerative colitis and familial polyposis and early results are favorable. The double stapling technique provides a safe method for rectal reconstruction at or near the dentate line and offers the following advantages over other stapler techniques: (1) It eliminates the frustrating distal pursestring; (2) The rectal segment is not opened, minimizing contamination; and (3) It avoids gathering the sometimes generous circumference of the rectum on a pursestring thus allowing a more precise distal donut.
Résumé
La technique de double agrafage pour anastomose colorectale consiste en la fermeture du moignon rectal par une pince à agrafage linéaire suivie ensuite d'une anastomose par une pince à agrafage circulaire à travers la ligne d'agraphes du moignon. Le but de cet article est, d'après notre expérience avec cette technique, de revoir les résultats à distance et de tirer des conclusions sur le matériel autuellement disponible. Nous avons utilisé technique dans 80 cas d'anastomose primaire et dans 11 anastomoses secondaires lors du rétablissement de continuité après opération de Hartmann. Vingt et une de ces anastomoses étaient faites au niveau de la ligne pectinée. Cinquante-six patients avaient un cancer rectal, 29 avaient eu une diverticulose, 3, un cancer de l'ovaire alors qu'un malade avait une perforation traumatique, un autre, un volvulus, et un troisième, un prolapsus du rectum. Il y a eu très peu de complications chez ces 91 patients: 3 fuites anastomotiques (3.3%), un hémopéritoine post-opératoire (1.1%), et trois sténoses (3.3%). Il n'y a jamais, été pratiqué de colostomie de protection. La mortalité était nulle. Des 43 patients avec cancer suivis jusqu'à présent, 4 ont présenté une récidive locale. La technique a été modifiée pour la réalisation de l'anastomose iléoanale après coloproctectomie pour rectocolite ou polypose familiale: les résultats initiaux sont encourageants. La technique de double agrafage est une méthode de reconstruction sûre pour les anastomoses à proximité de ou au niveau de la ligne pectinée. Cette technique offre des avantages par rapport à d'autres techniques d'agrafage: 1) le problème frustrant de la confection d'une bourse distale est éliminé; 2) le moignon rectal n'est pas ouvert, minimisant la contamination; 3) on évite de froisser de tissu rectal, parfois un peu abondant par rapport au diamètre de segment abaissé, ce qui permet alors une anastomose congruente.
Resumen
La técnica de doble grapado para la reconstrucción del recto luego de una resección implica el cierre del segmento distal con un grapador lineal y la constructión de la anastomosis mediante el uso de un grapador circular. El propósito de este informe es revisar los resultados con el uso del grapador doble, presentar nuestra experiencia y derivar conclusiones a partir del material estudiado. Hemos utilizado la tecnica de doble grapado en 80 anastomosis primarias y en 11 secundarias después de un procedimiento de Hartmann. Veinituna anastomosis quedaron ubicadas en la línea dentada, o muy cerca de ella. Cincuenta y seis pacientes tenían carcinoma rectal, 29 diverticulitis, 3 carcinoma del ovario, 1 perforación traumática del recto, 1 volvulos y 1 prolapso rectal. Las complicaciones observadas en el grupo combinado de 91 casos incluyeron 3 fugas anastomóticas (3.3%), 1 hemoperitoneo postoperatorio (1.1%) y 3 estrecheces. Ninguna anastomosis fue protegida con colostomía proximal. No hubo muertes postoperatorias. De 43 pacientes con cáncer disponibles para seguimiento, 4 desarrollaron recurrencia local. La técnica ha sido modificada para efectuar una anastomosis ileoanal en el curso de una protocolectomía abdominal restaurativa por colitis ulcerativa y poliposis familiar y los resultados tempranos aparecen favorables. La técnica de doble grapado representa un método seguro de reconstrucción rectal al nivel de o cerca de la línea dentada, y ofrece la siguientes ventajas sobre otras técnicas de grapado 1) elimina la frustrante jareta distal. 2) No se abre el segmento distal del recto, con lo cual se minimiza la contamización. 3) Evita la reducción de la frecuentemente generosa circuferencia del recto en una jareta, con lo cual se logra un “donut” distal más preciso.
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Dean Griffen, F., Knight, C.D. & Knight, C.D. Results of the double stapling procedure in pelvic surgery. World J. Surg. 16, 866–871 (1992). https://doi.org/10.1007/BF02066983
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DOI: https://doi.org/10.1007/BF02066983