Circular stapling techniques for low anterior resection of rectal carcinoma

This report provides our experience in 103 patients with adenocarcinoma of the rectum along with a general overview of the use of circular stapler in rectal surgery.

Forty-two patients were randomized to a rectal anastomosis using either the single (SST) or double stapling technique (DST).

From February 1991 to the present, 61 consecutive patients were treated to a rectal anastomosis using the DST. Perioperative mortality was 4.7 percent unrelated to the use of staplers. Statistically significant differences were noted: the mean distal resection margin measured 25.3 mm for SST and 35.0 mm for DST (p = 0.0274), without doughnut rings. Anastomotic stricture occurred in 3 patients (25%) using the 28-mm cartridge and in 1 (1.4%) using the 31-mm cartridge, respectively (p = 0.0082). To evaluate the different stapling techniques with bacterial contamination, the drain fluid was examined for lysozyme activity. When the SST was used, statistically significant enzyme activity increased as compared with the DST. Clinical leaks were noted in 9.5 percent (2/21) of the SST and in 2.4 percent (2/82) of the DST. The median follow-up of patients in the randomized study was 45 months (range, 32-62 months). Of the patients who underwent a potentially curative resection, seven (17.9 percent) developed a local recurrence, with no statistically significant differences in the stapling techniques of local recurrence and overall survival.

Our experience, and that reported in literature, suggests that the double stapling technique is useful for restorative resection of rectal cancers.