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Published on: November 4, 2010
Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after
Masaaki Ito1, Masanori Sugito, Akihiro Kobayashi
1Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. maito@east.ncc.go.jp
Background:
We experienced some technical difficulty in dividing the middle and lower rectum through the right-lower quadrant intracorporeally. The aim of this study was to determine whether multiple stapler firings during rectal division are associated with anastomotic leakage after laparoscopic rectal resection.
Methods:
Laparoscopic anterior resection with double-stapling technique anastomosis was performed in 180 consecutive rectal cancer patients. We often used vertical rectal division through a suprapubic site instead of the standard transverse rectal division for laparoscopic total mesorectal excision (LapTME). We attempted to determine whether there was an association between the number of stapler firings and procedures in rectal division. Moreover, we identified risk factors for anastomotic leakage after laparoscopic rectal resection by multivariate analysis.
Results:
Anastomotic leakage occurred in 5% of the subjects of this study. Vertical rectal division through the suprapubic site after Lap TME required fewer staples than transverse division through the right-lower port and a smaller percentage of patients required three or more staples for vertical rectal division than for transverse division (15% vs. 45%, p=0.03). In the multivariate analysis, TME and the number of staplers used for rectal division were the factors found to be associated with a significantly greater risk of subsequent leakage (odd's ratio=5.3; 95% CI 1.2-22.7 and odd's ratio=4.6; 95% CI 1.1-19.2).
Conclusion:
TME and multiple stapler firings during distal rectal division were associated with anastomotic leakage after laparoscopic rectal resection. Vertical rectal division through a suprapubic site was a useful method of avoiding multiple stapler firings during laparoscopic TME.
Insights
Multiple stapler firings during laparoscopic rectal resection increase the risk of anastomotic leakage. Vertical rectal division through a suprapubic site can help avoid multiple firings, reducing leakage risk.
Area of Science:
- Colorectal surgery
- Surgical oncology
- Minimally invasive surgery
Background:
- Technical difficulties in intracorporeal rectal division can occur.
- Anastomotic leakage is a significant complication after laparoscopic rectal resection.
Purpose of the Study:
- To determine if multiple stapler firings during rectal division correlate with anastomotic leakage.
- To identify risk factors for anastomotic leakage in laparoscopic rectal resection.
Main Methods:
- 180 patients undergoing laparoscopic anterior resection with double-stapling technique anastomosis were analyzed.
- Rectal division methods (vertical suprapubic vs. transverse right-lower quadrant) and stapler firings were recorded.
- Multivariate analysis identified risk factors for anastomotic leakage.
Main Results:
- Anastomotic leakage occurred in 5% of patients.
- Vertical rectal division required fewer staples than transverse division (15% vs. 45% requiring three or more staples).
- Total mesorectal excision (TME) and increased stapler use were associated with higher leakage risk (OR=5.3 and OR=4.6, respectively).
Conclusions:
- Total mesorectal excision (TME) and multiple stapler firings are linked to anastomotic leakage.
- Vertical rectal division through a suprapubic site is an effective technique to minimize stapler firings during laparoscopic TME, potentially reducing leakage.
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