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The double stapling technique for low anterior resection of rectal carcinoma

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Diseases of the Colon & Rectum

Abstract

The double stapling technique (TA-55® and EEA® staplers) was used to perform low anterior resections for rectal carcinomas in 79 patients (49 men, 30 women). The mean age was 66 years (range, 38 to 85 years). Curative resections were performed in 68 patients, and palliative resections in 11 patients. The mean level of the cancer from the dentate line was 9 cm (range, 5 to 16 cm). The mean follow-up has been 29 months (range, four to 58 months). Perioperative mortality was 2.5 percent (two patients). Technical problems related to the stapling technique occurred in 6 percent (five patients). The clinical anastomotic leak rate was 8 percent (six patients). There were 11 local recurrences among 68 curative resections (16 percent). Local recurrence according to individual surgeon showed marked variability (range, 0–43 percent,P>0.05). There were no differences in location, differentiation, or stage in those that recurred. The mean distal resection margin for the recurrent cancer group was 3.0 cm and for the nonrecurrent group, 2.9 cm. Disturbances of continence were seen commonly (56 percent) in the first three months after surgery, but 85 percent of patients became fully continent with an acceptable bowel habit at later follow-up. The double stapling technique is useful for the restorative resection of suitable mid and low rectal cancers. The anastomotic leak rate, local recurrence rate, and functional results are acceptable.

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References

  1. Knight CD, Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 1980; 88: 710–4.

    PubMed  CAS  Google Scholar 

  2. Cohen Z, Myers E, Langer B, Taylor B, Railton RH, Jamieson C. Double stapling technique for low anterior resection. Dis Colon Rectum 1983;26:231–5.

    Article  PubMed  CAS  Google Scholar 

  3. Ravitch MM, Steichen FM. A stapling instrument for end-to-end inverting anastomoses in the gastrointestinal tract. Ann Surg 1979;189:791–7.

    Article  PubMed  CAS  Google Scholar 

  4. Goligher JC. Use of circular stapling gun with peranal insertion of anorectal purse-string suture for construction of very low colorectal or colo-anal anastomoses. Br J Surg 1979;66:501–4.

    PubMed  CAS  Google Scholar 

  5. Julian TB, Ravitch MM. Evaluation of the safety of end-to-end (EEA) stapling anastomoses across linear stapled closures. Surg Clin North Am 1984;65:567–77.

    Google Scholar 

  6. Hughes KS, Happ RA. A simple device to facilitate the “double stapling technique” for low anterior resection. Dis Colon Rectum 1984;27:684–5.

    Article  PubMed  CAS  Google Scholar 

  7. Beart RW Jr, Kelly KA. Randomized prospective evaluation of the EEA stapler for colorectal anastomoses. Am J Surg 1981;141:143–6.

    Article  PubMed  Google Scholar 

  8. Goligher JC, Lee PW, Lintott DJ. Experience with the Russian model 249 suture gun for anastomosis of the rectum. Surg Gynecol Obstet 1979;148:517–24.

    Google Scholar 

  9. Dorsey JS, Stone RM. Colorectal anastomosis with a surgical stapler. Can J Surg 1981;24:555.

    PubMed  CAS  Google Scholar 

  10. Heald RJ, Leicester RJ. The low stapled anastomosis. Dis Colon Rectum 1981;24:437–44.

    PubMed  CAS  Google Scholar 

  11. Goligher JC, Dukes CE, Bussey HJ. Local recurrences after sphincter-saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg 1951;39:199–211.

    PubMed  CAS  Google Scholar 

  12. Tyndal EC, Dockerty MB, Waugh JM. Pelvic recurrence of carcinoma of the rectum. Surg Gynecol Obstet 1964;118:47–51.

    PubMed  CAS  Google Scholar 

  13. Leff EI, Shaver JO, Hoexter B, et al. Anastomotic recurrences after low anterior resection: stapled vs. hand-sewn. Dis Colon Rectum 1985;28:164–7.

    PubMed  CAS  Google Scholar 

  14. Rosen CB, Beart RW Jr, Hstrup DM. Local recurrence of rectal carcinoma after hand-sewn and stapled anastomoses. Dis Colon Rectum 1985;28:305–9.

    PubMed  CAS  Google Scholar 

  15. Williams NS, Johnson D. Survival and recurrence after sphincter saving resection and abdominoperinal resection for carcinoma of the middle third of the rectum. Br J Surg 1984;71:278–82.

    PubMed  CAS  Google Scholar 

  16. Kennedy HL, Langevin JM, Goldberg SM, Christenson CE, Rothenberger DA. Recurrence following stapled coloproctostomy for carcinomas of the mid portion of the rectum. Surg Gynecol Obstet 1985;160:513–6.

    PubMed  CAS  Google Scholar 

  17. Hurst PA, Prout WG, Kelly JM, Bannister JJ, Walker RT. Local recurrence after low anterior resection using the staple gun. Br J Surg 1982;69:275–6.

    PubMed  CAS  Google Scholar 

  18. Patel SC, Tovee EB, Langer B. Twenty-five years of experience with radical surgical treatment of carcinoma of the extraperitoneal rectum. Surgery 1977;82:460–5.

    PubMed  CAS  Google Scholar 

  19. Black WA, Waugh JM. The intramural extension of carcinoma of the descending colon, sigmoid and rectosigmoid: a pathologic study. Surg Gynecol Obstet 1948;87:457–64.

    Google Scholar 

  20. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg 1983;70:150–4.

    PubMed  CAS  Google Scholar 

  21. Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 1983;198:159–63.

    Article  PubMed  CAS  Google Scholar 

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Read at the meeting of the American Society of Colon and Rectal Surgeons, Houston, Texas, May 11 to 15 1986.

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Feinberg, S.M., Parker, F., Cohen, Z. et al. The double stapling technique for low anterior resection of rectal carcinoma. Dis Colon Rectum 29, 885–890 (1986). https://doi.org/10.1007/BF02555370

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