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Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer

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Abstract

Purpose

Proper transection of the distal rectum is important for reconstruction of bowel continuity in rectal cancer surgery. In this study, we introduced a modified technique for ligation of the distal rectum, and investigated its safety and efficiency to facilitate the rectum transection.

Methods

After complete mobilization and transection of the mesorectum, a cable tie was carefully positioned distal to the tumor, followed by washout and transecting the rectum with a linear stapler. From September 2017 to June 2018, consecutive 67 mid-low rectal cancer patients with laparoscopic anterior resection underwent this technique. Clinical data of these patients, including number of firings, pathological and operative variables, and postoperative outcomes, were compared with those of 132 consecutive patients who underwent traditional surgery from January 2016 to August 2017.

Results

Compared with the traditional method, cable tie ligation significantly reduced the number of firings (1.1 ± 0.32 vs. 1.3 ± 0.52, p < 0.001). A very high ratio of one firing transection of rectum was observed in the cable tie group (94.0% vs. 68.9%, p < 0.001), even in patients with tumor at or below the peritoneal reflection (90.2% vs. 54.4%, p < 0.001), in male patients (95.5% vs. 65.8%, p < 0.001), and in obese patients (93.8% vs. 64.9%, p = 0.005). The mean distal margin was longer in the cable tie group (3.19 ± 1.77 cm vs. 2.54 ± 1.36 cm, p = 0.005), with no positive distal margin observed. The operation time, quality of mesorectum, and morbidity between two groups were comparable. Two leaks (3.0%) in the cable tie group were observed, similar to 3.8% in the control.

Conclusions

Ligation of the rectum with a cable tie reduces the number of cartridges, and increases the rate of one stapler firing for rectal transection, even in those difficult cases like male, overweight, and low rectal cancer patients. It is also useful for occlusion of the rectum before washout. It is safe, feasible, and worthwhile for popularization.

Trial registration

Registered at ClinicalTrial.gov, number NCT03570684

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Funding

This study was funded by the Ministry of Science and Technology of the People’s Republic of China (grant No. 2017YFC0908200) and Scientific and Technology Department of Sichuan Province (grant No. 2018SZ0242).

Author information

Author notes

  1. Liang Bi, Xiangbing Deng and Xia Meng contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China

    Liang Bi, Xiangbing Deng, Xuyang Yang, Mingtian Wei, Qingbin Wu & Ziqiang Wang

  2. Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China

    Xia Meng

  3. Department of Gastrointestinal Surgery, Nanchong Central Hospital, Nanchong, Sichuan, China

    Minyang Ren

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  1. Liang Bi
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  2. Xiangbing Deng
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Contributions

Minyang Ren and Ziqiang Wang contributed to the study conception and design; Xiangbing Deng, Liang Bi, Xuyang Yang, Mingtian Wei, and Qingbin Wu contributed to the acquisition of data, analysis, and interpretation of data for the submission; Xiangbing Deng drafted the submission; Xia Meng made the video; Liang Bi, Xiangbing Deng, Xia Meng, and Ziqiang Wang revised the manuscript.

Corresponding authors

Correspondence to Minyang Ren or Ziqiang Wang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consents were obtained from all individual participants whom receive the cable tie procedure; for the patients with grasping forceps, as a retrospective control group and common practice, the informed consents were not obtained.

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Bi, L., Deng, X., Meng, X. et al. Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer. Langenbecks Arch Surg 405, 233–239 (2020). https://doi.org/10.1007/s00423-020-01863-6

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  • DOI: https://doi.org/10.1007/s00423-020-01863-6

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