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Experience with the use of the circular stapler in rectal surgery

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Diseases of the Colon & Rectum

Abstract

This report provides our personal experience along with a general overview of the use of the circular stapler in rectal surgery. To determine the results of our experience with the use of the circular stapler for construction of anastomoses following resection, a series of 215 anastomoses performed in 214 patients was reviewed. The patients ranged in age from 33 to 88 years. There were 116 men and 98 women. Indications for operation included malignancy, diverticular disease, villous adenoma, Crohn's disease, and rectal procidentia. The types of operation performed included removal of varying portions of the large bowel. The anastomosis was performed in a uniform manner with the EEA®(United States Surgical Corp., Norwalk, CT) and more recently the CEEA™(United States Surgical Corp., Norwalk, CT). The operative mortality was 0.47 percent, with the death being unrelated to the anastomosis. Intraoperative complications encountered included bleeding, difficult extraction, instrument failure, incomplete doughnuts, deficient anastomoses, and miscellaneous problems. Early postoperative complications included one leak and a number of complications unrelated to the anastomoses. Anastomotic stenosis developed in 27 patients, but only 8 were permanent and only 3 of these were symptomatic. Two of these patients were treated with balloon dilatation. Anastomotic recurrences developed in 131 percent of patients. Our experience gained with the circular stapling device and that reported in the literature have shown it to be a reliable method of performing anastomoses to the rectum in a safe and expeditious manner.

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References

  1. Steichen FM, Ravitch MM. Stapling in surgery. Chicago: Year Book Medical Publishers, 1984:271.

    Google Scholar 

  2. Ravitch MM. Second thoughts of a surgical curmudgeon. Chicago: Year Book Medical Publishers, 1987.

    Google Scholar 

  3. Gordon PH, Dalrymple S. The use of staples for reconstruction after colonic and rectal surgery. In: Ravitch MM, Steichen FM, eds. Principles and practice of surgical stapling. Chicago: Year Book Medical Publishers, 1987:402–31.

    Google Scholar 

  4. Gordon PH, Vasilevsky CA. Experience with stapling in rectal surgery. Surg Clin North Am 1984;64:555–66.

    PubMed  CAS  Google Scholar 

  5. Gordon PH. Malignant neoplasms of the rectum. In: Gordon PH, Nivatvongs S, eds. Principles and practice of surgery for the colon, rectum and anus. St. Louis: Quality Medical Publishing, 1992:591–653.

    Google Scholar 

  6. Tchervenkov CI, Gordon PH. Simple techniques of enlarging the diameter of the bowel lumen for the performance of end-to-end anastomoses using the EEA stapler. Dis Colon Rectum 1984;27:630–1.

    PubMed  CAS  Google Scholar 

  7. Smith LE. Anastomosis with EEA stapler after anterior colonnc resection. Dis Colon Rectum 1981;24:236–46.

    PubMed  CAS  Google Scholar 

  8. Kirkegaard P, Christianson J, Hjortrup A. Anterior resection for midrectal cancer with the EEA stapling instrument. Am J Surg 1980;140:312–4.

    PubMed  CAS  Google Scholar 

  9. Laitinen S, Huttunen R, Stahlberg M, Mokka R, Kairaluoma M, Larmi TK. Experiences with the EEA stapling instrument for colorectal anastomosis. Ann Chir Gynaecol 1980;69:102–5.

    PubMed  CAS  Google Scholar 

  10. Brown AA, Gasson JE, Brown RA. Experience with the EEA stapler in carcinoma of the lower rectum. S Afr Med J 1981;21:258–61.

    Google Scholar 

  11. Cade D, Gallagher P, Schofield PF, Turner L. Complications of anterior resection of the rectum using the EEA stapling device. Br J Surg 1981;68:339–40.

    PubMed  CAS  Google Scholar 

  12. Cutait DE, Cutait R, DaSilva JH,et al. Stapled anastomosis in colorectal surgery. Dis Colon Rectum 1981;24:155–60.

    Article  PubMed  CAS  Google Scholar 

  13. Heald RJ, Leicester RJ. The low stapled anastomoses. Br J Surg 1981;68:333–7.

    PubMed  CAS  Google Scholar 

  14. Killingback M. Intrapelvic restorative resection for carcinoma of the large bowel. Hunterian lecture. Ann R Coll Surg Engl 1981;Apr 1:1–52.

    Google Scholar 

  15. Dorricott NJ, Braddley RM, Keighley MR, Lee J, Oates GD, Alexander-Williams J. Complications of rectal anastomoses with end-to-end anastomosis (EEA) stapling instrument. Ann R Coll Surg Engl 1982;64:171–4.

    PubMed  CAS  Google Scholar 

  16. Friis J, Hjortrup A, Nielson OV. Sphincter-saving resection of the rectum using the EEA auto staples. Acta Chir Scand 1982;148:379–81.

    PubMed  CAS  Google Scholar 

  17. Goligher JC. The use of circular staplers for the construction of colorectal anastomoses after anterior resection. In: Heberer G, Denecke H, eds. Colorectal surgery. Berlin: Springer-Verlag, 1982:107–13.

    Google Scholar 

  18. Hamelmann H, Thiede A, Jostarndt L, Troidl H. Stapler anastomoses in the low rectal third. In: Heberer G, Denecke H, eds. Colorectal surgery. Berlin: Springer-Verlag, 1982:115–9.

    Google Scholar 

  19. Helm W, Rowe PH. Rectal anastomosis with the EEA stapling instrument. Ann R Coll Surg Engl 1982;64: 356–7.

    PubMed  CAS  Google Scholar 

  20. Leff EI, Hoexter B, Labow SB, Eisenstat TE, Rubin RJ, Salvati EP. The EEA stapler in low colorectal anastomoses: initial experience. Dis Colon Rectum 1982;25:704–7.

    PubMed  CAS  Google Scholar 

  21. Polglase AL, Cunningham IG, Hughes ESR, Masterson JP. Initial clinical experience with the EEA stapler. Aust N Z J Surg 1982;52:71–5.

    PubMed  CAS  Google Scholar 

  22. Vezeridis M, Evans TJ, Mittelman A, Ledesma EJ. EEA stapler in low anterior anastomosis. Dis Colon Rectum 1982;25:364–7.

    PubMed  CAS  Google Scholar 

  23. Anderberg B, Enblad P, Sjodahl R, Wetterfors J. The EEA stapling device in anterior resection for carcinoma of the rectum. Br J Surg 1983;149:99–103.

    CAS  Google Scholar 

  24. Fegiz G, Angelini L, Bezzi M. Rectal cancer: restorative surgery with the EEA stapling device. Int Surg 1983;68:13–8.

    PubMed  CAS  Google Scholar 

  25. Isbister WH, Beasley SW, Dowle CS. The EEA stapler-a Wellington experience. Coloproctology 1983;6:323–6.

    Google Scholar 

  26. Kennedy HL, Rothenberger DA, Goldberg SM,et al. Colocolostomy and coloproctostomy utilizing the circular intraluminal stapling devices. Dis Colon Rectum 1983;26:145–8.

    PubMed  CAS  Google Scholar 

  27. Resnick SD, Burstein AE, Viner YL. Use of the stapler in anterior resection for cancer of the rectosigmoid. Isr J Med Sci 1983;19:128–33.

    PubMed  CAS  Google Scholar 

  28. Fazio VW. Advances in the surgery of rectal carcinoma utilizing the circular stapler. In: Spratt JS, ed. Neoplasms of the colon, rectum and anus. Philadelphia: WB Saunders, 1984:268–88.

    Google Scholar 

  29. Hedberg SE, Helmy AH. Experience with gastrointestinal stapling at the Massachusetts General Hospital. Surg Clin North Am 1984;64:511–28.

    PubMed  CAS  Google Scholar 

  30. Fazio VW, Jagelman DG, Lavery IC, McGonagle BA. Evaluation of the proximate ILS circular stapler: a prospective study. Ann Surg 1985;201:108–14.

    PubMed  CAS  Google Scholar 

  31. McGinn FP, Gartell PC, Clifford PC, Brunton FJ. Staples or sutures for low colorectal anastomoses: a prospective randomized trial. Br J Surg 1985;72:603–5.

    PubMed  CAS  Google Scholar 

  32. Gillen P, Peel AL. Comparison of the mortality, morbidity and incidence of local recurrence in patients with rectal cancer treated by either stapled anterior resection or abdominoperineal resection. Br J Surg 1986;73:339–41.

    PubMed  CAS  Google Scholar 

  33. Antonsen HK, Kronborg O. Early complications after low anterior resection for rectal cancer using the EEA stapling device: a prospective trial. Dis Colon Rectum 1987;30:579–83.

    PubMed  CAS  Google Scholar 

  34. Kantarzis M, Lersmacher J, Winter J, Hoffman E. Experience and results with the Russian circular SPTU instrument. In: Ravitch MM, Steichen FM, Welter R, eds. Current practice of surgical stapling. Philadelphia: Lea & Febiger, 1991:55–7.

    Google Scholar 

  35. Zannini G, Renda A, Lepore R, Coppola L, Landi R, Dantonio M. Mechanical anterior resection for carcinoma of the mid rectum: long term results. Int Surg 1987;72:18–9.

    PubMed  CAS  Google Scholar 

  36. Belli L, Beati CA, Frangi M, Aseni P, Rondinara GF. Outcome of patients with rectal cancer treated by stapled anterior resection. Br J Surg 1988;75:422–4.

    PubMed  CAS  Google Scholar 

  37. Malmberg M, Graffner H, Ling L, Olsson SA. Recurrence and survival after anterior resection of the rectum using the end to end anastomotic stapler. Surg Gynecol Obstet 1986;163:231–4.

    PubMed  CAS  Google Scholar 

  38. Dehong Y, Yue T, Qinglan C, Guoxiang J, Ronggui M, Libing C. Anterior resection with EEA stapler and manual sutures: comparison of two patient groups. In: Ravitch MM, Steichen FM, Welter R, eds. Current practice of surgical stapling. Philadelphia: Lea & Febiger, 1991:101–3.

    Google Scholar 

  39. Steegmuller KW, Brown S. Experience with 140 stapled colorectal anastomoses. In: Ravitch MM, Steichen FM, Welter R, eds. Current practice of surgical stapling. Philadelphia: Lea & Febiger, 1991:269–71.

    Google Scholar 

  40. 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 

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

    PubMed  Google Scholar 

  42. Adloff M, Arnaud JP, Beehary S. Stapledvs. sutured colorectal anastomosis. Arch Surg 1980;115:1436–8.

    PubMed  CAS  Google Scholar 

  43. Scher KS, Scott-Conner C, Jones CW, Leach M. A comparison of stapled and sutured anastomoses in colonic operations. Surg Gynecol Obstet 1982;155:489–93.

    PubMed  CAS  Google Scholar 

  44. Goligher JC. The use of stapling devices for the construction of low rectal anastomoses. Ann Chir Gynaecol 1980;69:125–31.

    PubMed  CAS  Google Scholar 

  45. Heald RJ. Towards fewer colostomies—the impact of circular stapling devices on the surgery of rectal cancer in the district hospital. Br J Surg 1980;67:198–200.

    PubMed  CAS  Google Scholar 

  46. Jarvinen HJ, Ovaska J, Mecklin JP. Improvements in the treatment and prognosis of colorectal carcinoma. Br J Surg 1988;75:25–7.

    PubMed  CAS  Google Scholar 

  47. Odou MW, O'Connell TX. Changes in the treatment of rectal carcinoma and effects on local recurrence. Arch Surg 1986;121:1114–6.

    PubMed  CAS  Google Scholar 

  48. Griffin FD, Knight CD, Whittaker JM. The double stapling technique for low anterior resection. Ann Surg 1990;211:745–52.

    Article  Google Scholar 

  49. Feinberg SM, Parker F, Cohen Z,et al. The double stapling technique for low anterior resection of rectal carcinoma. Dis Colon Rectum 1986;29:885–90.

    PubMed  CAS  Google Scholar 

  50. Julian TB, Ravitch MM. Evaluation of the safety of end-to-end (EEA) stapling anastomosis across linear stapled closures. Surg Clin North Am 1984;64:567–77.

    PubMed  CAS  Google Scholar 

  51. Trollope ML, Cohen RG, Lee RH, Cannon WB, Marzonni FA, Cressman RD. A seven year experience with low anterior sigmoid resections using the EEA stapler. Am J Surg 1986;152:11–15.

    PubMed  CAS  Google Scholar 

  52. Minichan DP. Enlarging the bowel lumen for the EEA stapler. Dis Colon Rectum 1982;25:61.

    PubMed  Google Scholar 

  53. 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 

  54. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 1982;69:13–6.

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  56. Luke M, Kirkegaard P, Lendorf A, Christiansen J. Pelvic recurrence rate after abdominoperineal resection and low anterior resection for rectal cancer before and after introduction of the stapling technique. World J Surg 1983;7:616–9.

    PubMed  CAS  Google Scholar 

  57. Kennedy HL, Langevin JM, Goldberg SM,et al. Recurrence following stapled coloproctostomy for carcinomas of the mid portion of the rectum. Surg Gynecol Obstet 1985;160:513–6.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  59. Wolmark N, Gordon PH, Fisher B,et al. A comparison of stapled and hand sewn anastomoses in patients undergoing resection for Dukes' B and C colorectal cancer: an analysis of disease free survival and survival from NSABP randomized clinical trials. Dis Colon Rectum 1986;29:344–50.

    PubMed  CAS  Google Scholar 

  60. Carlsson V, Lasson A, Ekelund G. Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy. Dis Colon Rectum 1987;30:431–4.

    PubMed  CAS  Google Scholar 

  61. Colombo PL, Foglieni CL, Morone C. Analysis of recurrence following curative low anterior resection and stapled anastomosis for carcinoma of the middle third and lower rectum. Dis Colon Rectum 1987;30:457–64.

    PubMed  CAS  Google Scholar 

  62. Neville R, Fielding LP, Amendola C. Local tumor recurrence after curative resection for rectal cancer: a ten hospital review. Dis Colon Rectum 1987;30:12–17.

    PubMed  CAS  Google Scholar 

  63. McDermott F, Hughes ES, Pihl E, Milne BJ, Price A. Long-term results of restorative resection and total excision for carcinoma of the middle third of the rectum. Surg Gynecol Obstet 1982;154:833–7.

    PubMed  CAS  Google Scholar 

  64. Nicholls RJ, Ritchie JK, Wadsworth J, Parks AG. Total excision or restorative resection for carcinoma of the middle third of the rectum. Br J Surg 1979;66:625–7.

    PubMed  CAS  Google Scholar 

  65. Slanetz CA, Herter FP, Grinnell RS. Anterior resection versus abdominoperineal resection for cancer of the rectum and rectosigmoid. Am J Surg 1972;123:110–5.

    PubMed  Google Scholar 

  66. Williams NS, Durdy P, Johnston D. The outcome following sphincter saving resection and abdominoperineal resection for low rectal cancer. Br J Surg 1985;72:595–8.

    PubMed  CAS  Google Scholar 

  67. Williams NS, Johnston D. Survival and recurrence after sphincter saving resection and abdominoperineal resection for carcinoma of the middle third of the rectum. Br J Surg 1984;74:278–82.

    Google Scholar 

  68. Wolmark N, Fisher B. An analysis of survival and treatment failure following abdominoperineal and sphincter saving resection in Dukes' B and C rectal carcinoma. A report of the NSABP Clinical Trials. Ann Surg 1986;204:480–9.

    PubMed  CAS  Google Scholar 

  69. Localio SA. Surgery of colorectal cancer. Can J Surg 1978;21:214–5.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital Hospital and McGill University, Montreal, Quebec, Canada

    Shlomo Kyzer M.D. & Philip H. Gordon M.D.

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  1. Shlomo Kyzer M.D.
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  2. Philip H. Gordon M.D.
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This study was conducted with support from The Sir Mortimer B. Davis Jewish General Hospital Foundation and The American Physician Fellowship.

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Kyzer, S., Gordon, P.H. Experience with the use of the circular stapler in rectal surgery. Dis Colon Rectum 35, 696–706 (1992). https://doi.org/10.1007/BF02053764

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