A rare complication of laparoscopic low anterior resection

We report a 70-year-old lady who suffered from carcinoma of rectum with the lowest border of the tumor at 5 cm from the anal verge. Preoperative staging did not show any distant metastasis. Laparoscopic low anterior resection with total mesorectal excision was performed. The rectum was transected with endoscopic stapler and a double stapling anastomosis with a circular stapler was attempted. The spear of the circular stapler pierced through the rectal stump and attempt to remove the spear by pulling the suture attached to the spear failed. A pair of strong laparoscopic forceps was used in an attempt to remove the spear. The spear broke during the attempt of removal. The stapler was withdrawn through the anus with a pair of laparoscopic forceps following it. A new circular stapler was used and the tip was tied to a suture and cotton tape. The pair of forceps, which was still at the anus, was used to pull the cotton tape and the suture through the original perforation at the rectal stump. The tip of the spear of the new stapler was guided through the original perforation of the rectal stump. Double stapling was then performed and the patient recovered uneventfully. This case showed that stapler complication in laparoscopic surgery could be salvaged without conversion.