Modified double-stapling technique in low anterior resection for lower rectal carcinoma

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• The standard double-stapling technique (DST) can be challenging in narrow pelvis or ultralow anastomosis scenarios.
• Low anterior resection (LAR) for lower rectal carcinoma requires precise anastomotic techniques.

Purpose of the Study:

• To evaluate the feasibility and outcomes of a modified double-stapling technique (IO-DST) using an endostapler for vertical rectal division.
• To compare IO-DST with the single-stapling technique (SST) and per anal anastomosis (PAA).

Main Methods:

• Retrospective study of 90 patients undergoing LAR for lower rectal carcinoma.
• Patients were divided into three groups: IO-DST (34), SST (47), and PAA (9).
• Clinical outcomes including anastomotic distance, blood loss, operative time, and complications were analyzed.

Main Results:

• IO-DST achieved significantly shorter distances from the anal verge to the tumor and anastomosis compared to SST.
• Reduced blood loss and operative time were observed in the IO-DST group compared to SST and PAA.
• Patients in the IO-DST group experienced less bowel frequency post-surgery compared to SST and PAA groups.
• No significant differences in distal surgical margin length, complication rates, or local recurrence were found.

Conclusions:

• The intraoperative endostapler double-stapling technique (IO-DST) is a safe and feasible option for low anastomosis in LAR.
• IO-DST leads to improved functional outcomes, specifically reduced bowel frequency, after surgery for lower rectal carcinoma.