Abstract
Background
Anastomotic leakage is a major cause of postoperative morbidity and mortality in the treatment of colorectal cancer. The aim of this study was to investigate the modified double-stapling technique (MDST), as an alternative for conventional double-stapling technique (DST), and whether it could reduce the anastomotic leakage rate in laparoscopic anterior resection (Lapa-AR).
Study Design
Between March 2009 and October 2010, a total of 189 patients who underwent Lapa-AR for the treatment of adenocarcinoma of the sigmoid colon or rectosigmoid colon were divided into the MDST group (n = 95) and the DST group (n = 94) according to the anastomotic technique. Data were analyzed retrospectively. Morbidity and anastomotic leakage rate were compared between the two groups.
Results
Patient demographics, preoperative comorbidity, tumor size, stage, and operative details were comparable between the two groups. There was no difference in operation time between the two groups. The overall complication rate was significantly lower in the MDST group than in the DST group (3.2 vs. 10.6 %, p = 0.042), including anastomotic leakage rate (0 vs.4.6 %, p = 0.029). The anastomotic technique was the only factor associated with anastomotic leakage in univariate analysis.
Conclusions
Our comparative study demonstrates MDST to have better short-term outcome in reducing anastomotic leakage compared with DST. This technique could be an alternative approach to maximize the patients' benefit in laparoscopic anterior resection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 2005;92(9):1150–1154.
Kube R, Mroczkowski P, Granowski D, et al. Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival. Eur J Surg Oncol 2010;36(2):120–124.
Knight CD, Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 1980;88(5):710–714.
Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 1997;185(2):105–113.
Cohen Z, Myers E, Langer B, Taylor B, Railton RH, Jamieson C. Double stapling technique for low anterior resection. Dis Colon Rectum 1983;26(4):231–235.
Akiyoshi T, Ueno M, Fukunaga Y, et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Am J Surg 2011;202(3):259–264.
Kim JS, Cho SY, Min BS, Kim NK. Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 2009;209(6):694–701.
Marecik SJ, Chaudhry V, Pearl R, Park JJ, Prasad LM. Single-stapled double-pursestring anastomosis after anterior resection of the rectum. Am J Surg 2007;193(3):395–399.
Asao T, Kuwano H, Nakamura J, et al. Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses. Dis Colon Rectum 2002;45(1):137–139.
Kang J, Baek SE, Kim T, et al. Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Colorectal Dis 2012;27(4):497–505.
Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 2008;23(7):703–707.
Yeh CY, Changchien CR, Wang JY, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 2005;241(1):9–13.
Kang J, Min BS, Park YA, et al. Risk factor analysis of postoperative complications after robotic rectal cancer surgery. World J Surg 2011;35(11):2555–2562.
Kim MJ, Shin R, Oh HK, Park JW, Jeong SY, Park JG. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg 2011;35(12):2806–2810.
Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85(3):355–358.
Hinojosa MW, Murrell ZA, Konyalian VR, Mills S, Nguyen NT, Stamos MJ (2007) Comparison of laparoscopic vs open sigmoid colectomy for benign and malignant disease at academic medical centers. J Gastrointest Surg 11(11):1423–1429; discussion 1429–1430
Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 2011;25(9):2972–2979.
Moore JW, Chapuis PH, Bokey EL. Morbidity and mortality after single- and double-stapled colorectal anastomoses in patients with carcinoma of the rectum. Aust N Z J Surg 1996;66(12):820–823.
Moritz E, Achleitner D, Holbling N, Miller K, Speil T, Weber F. Single vs. double stapling technique in colorectal surgery. A prospective randomized trial. Dis Colon Rectum 1991;34(6):495–497.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kang, J., Lee, H.B., Cha, J.H. et al. Feasibility and Impact on Surgical Outcomes of Modified Double-Stapling Technique for Patients Undergoing Laparoscopic Anterior Resection. J Gastrointest Surg 17, 771–775 (2013). https://doi.org/10.1007/s11605-012-2122-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-012-2122-0