[Assessment of the transanal eversion technique using double purse-string forceps in laparoscopic anterior resection...

Objective: To investigate the safety and effectiveness of the transanal eversion technique using double purse-string forceps in laparoscopic anterior resection of middle-low rectal cancer. Methods: Clinical data of patients with middle-low rectal cancer undergoing laparoscopic anterior resection at the General Surgery Department of Henan Cancer Hospital from August 2015 to December 2018 were analyzed retrospectively. According to the inclusion and exclusion criteria, 238 patients were enrolled, including 36 patients in the double purse-string forceps method group and 202 patients in the traditional double-staplers method group. Propensity score matching (1∶3) was performed based on age, gender, body mass index (BMI), tumor size, distance from the tumor's lower margin to the anus, preoperative clinical stage, and neoadjuvant chemoradiotherapy. This resulted in 23 patients in the double purse-string forceps group and 69 in the double-staplers group. Surgical outcomes, pathological indicators, and postoperative complications were compared between the two groups. Results: Compared with the double-staplers method group, the double purse-string forceps group had a lower protective stoma rate [2/23 vs 18/69, P=0.049], a shorter incision length [(1.6±1.5) cm vs (4.7±1.1) cm, P＜0.01], and less postoperative pain [(3.9±1.9) points vs (4.8±1.5) points, P=0.024]. There were no significant differences in the length of specimen, distal margin length, number of lymph nodes dissected, number of positive lymph nodes and pTNM stage between the two groups (P＞0.05). There was no significant difference in complications including anastomotic leakage between the two groups (P＞0.05). Conclusions: The transanal eversion technique using double purse-string forceps in laparoscopic anterior resection of middle-low rectal cancer is safe and feasible by eliminating the ischemic area. This method can significantly reduce the ratio of protective stoma, shorten surgical incision length, and relieve postoperative pain.