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Sphincter-saving surgery for rectal and colorectal disorders
W F Van Tets1, J H Kuijpers, L J Mortelmans
1Dept. of Surgery of Groot Ziekengasthuis Den Bosch, University Hospital Nijmegen, St Jozef Ziekenhuis Veldhoven, The Netherlands.
Background:
Restoration of intestinal continuity by anal anastomosis after sphincter-saving rectal excision is feasible from an oncological, technical and functional standpoint. We present our experience.
Methods:
The records of 223 patients with an anal anastomosis were reviewed. The anal anastomosis was performed hand-sutured transanally in 92 patients and double-stapled transabdominally in 131 patients. Coloanal anastomosis was performed in 39 patients and ileoanal pouch anastomosis in 184 patients.
Results:
Operation time, blood loss and admission times were considerably less after double-stapling anastomosis. Relevant complications occurred in 15% after coloanal anastomosis and in 35% after ileoanal pouch anastomosis, failure rate was similar (13%). Complication (7% vs 43%) and failure rate (2% vs 27%) were less after double-stapled anastomosis. Prednisone did not influence the failure rate whereas previous abdominal surgery did.
Conclusions:
The double-stapling technique gives less complications and better results although effects of a learning curve are undoubtedly present in this series. The technique makes a temporary diverting ileostomy superfluous. The double-stapling technique is to be preferred for anal anastomoses.