Laparoscopic Lower Anterior Rectal Resection using a Curved Stapler: Original technique and preliminary experience.

Background Laparoscopic Low Anterior Rectal Resection (LLAR), allowing a better visualization and rectal mobilization, can reduce post-operative pain and recovery. Contour Curved Stapler (CCS) is a very helpful device because of its curved profile that consents a better access into the pelvic cavity and allows to perform rectal closure and section in one shot, especially in presence of narrow pelvis, complex anatomy or large tumors. We developed an original technique of laparoscopic rectal resection using CCS. Methods Between 2005 and 2009, in 36 cases we performed laparoscopic low rectal resection with 3 trocars technique, starting with mobilization of left colonic flexure followed by the section of inferior mesenteric vessels. The rectum was prepared up to levator ani with total mesorectal excision. The Lapdisc® was inserted trough a soprapubic midline incision, allowing the CCS stapler placement into the pelvic cavity. After the rectal section, the anastomosis was then performed with a circular stapler. Ileostomy was performed if neoadiuvant radiotherapy and chemotherapy have been carried out or if the anastomosis where below 4 cm from the anal verge. Results Mean operative time was 135 min and no intra- or post-operative bleeding occurred. In 27 patients we performed temporary ileostomy. In 2 cases we observed anastomotic leakage, one of these patients already had ileostomy. No anastomotic stenosis occurred after one year follow up. Conclusions This procedure simplifies the section of lower rectum, reduces leaking rate due to technical difficulties and not nullifies the benefits of laparoscopy.