Rectal cancer: restorative surgery with the EEA stapling device

In the surgical treatment of tumors of the middle third of the rectum, we have been performing low colorectal anastomoses, with the EEA stapler introduced transanally, as a sphincter-saving operation, during the last three years. Our experience covers 134 patients; in 89 of these, manual reconstruction was found to be technically impossible. In such cases, the alternative sphincter-saving operation, in our department, would be a pull-through operation. In 16.4%, anastomotic dehiscence with stercoraceous fistula was observed; the operative mortality was 1.4%. At follow-up, there were no colon problems, in 85.2%; in 13.7%, three or four defecations of formed stools occurred daily; in 6.8%, there was a reduction in the calibre of the anastomosis. In these patients, dilation was performed. Loss of the capacity to discriminate between feces and flatus and a poor control of flatus with occasional fecal incontinence were present in six and three patients, respectively. Clinical and functional results, when compared with those of other sphincter-saving operations, confirm that the use of the EEA stapler allows the construction of anastomoses so low in the rectum that it would be difficult, risky or impossible to perform them manually. A reduction in the incidence of anastomotic dehiscence and length of hospital stay was also obtained.