Can a curved stapler made for the open surgery be useful in laparoscopic lower rectal resections: Technique and experience of a single center

Background: The use of laparoscopy to perform lower anterior rectal resection is increasing worldwide because it allows a better visualization and rectal mobilization and also 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. In this paper, we present an original technique to use this device, made for open surgery, in laparoscopy and the results of our experience. Methods: We have retrospectively evaluated the data of all patients who underwent lower laparoscopic anterior rectal resection and in which was used the CCS to perform the section of the rectum between September 2005 and September 2011. To perform the section of the rectum a Lapdisc was inserted trough a 6e7 cm suprapubic midline incision to allow the placement of the CCS into the pelvic cavity. Patients biographical and surgical data such as sex, age, indication for surgery, infection, anastomotic leakage or stenosis and staple-line bleeding were prospectively collected in a computerized database and evaluated. Results: Between September 2005 and September 2011, we performed 45 laparoscopic lower rectal resection using CCS, 27 male and 18 female with a mean age of 61 yrs (range 40e82) and a mean Body Mass Index (BMI) 26.5 (range 16.5e35). In 29 cases a temporary ileostomy was performed. Mean operative time was 131 min (range 97e210). In all cases was possible to perform a lower section of the rectum with CCS. No intra-operative or post-operative staple line bleeding occurred. In 2 patients we observed anastomotic leaks and in one of these a temporary ileostomy was performed. None of the patients showed an anastomotic stenosis at one-year follow-up colonoscopy. Conclusions: This study shows that the CCS allows to easily perform lower rectum’s section, especially in adverse anatomical condition, and the technique proposed by us allows the use of this stapler without giving up the benefits of laparoscopic access.