Laparoscopic Low Anterior Resection with Two Planned Stapler Fires.

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Anastomotic leakage is a significant complication of laparoscopic low anterior resection (Lap-LAR) for rectal cancer.
• Multiple stapler fires during rectal transection are a known risk factor for iatrogenic anastomotic leakage.
• The standard technique at the institute involves two planned stapler fires followed by double-stapling anastomosis.

Purpose of the Study:

• To evaluate the safety and efficacy of a standardized technique using two planned stapler fires for rectal transection in Lap-LAR.
• To assess the incidence of anastomotic leakage and other complications associated with this technique.

Main Methods:

• A total of 272 consecutive patients underwent Lap-LAR with double-stapling anastomosis between November 2009 and September 2016.
• Rectal transection was performed using a linear 45-mm stapler, with the first fire completing three-quarters of the wall and the second completing the resection.
• The intersection of staple lines was positioned centrally for easy removal with a circular stapler to minimize leakage risk.

Main Results:

• No patients required conversion to open surgery.
• An accidental third stapler fire occurred in only one patient (0.4%).
• The incidence of rectovaginal fistula was 0.4% (1 patient), anastomotic leakage was 3.3% (9 patients), and 18.0% (49 patients) required a protective diverting stoma.

Conclusions:

• Rectal transection using two planned stapler fires is a safe, practical, and easily standardizable method for Lap-LAR.
• This technique effectively reduces the need for multiple linear stapler fires.
• The method contributes to a lower incidence of anastomotic leakage in rectal cancer surgery.