Long-term evaluation of a modified double staple technique for low anterior resection .

Background. When performing a low anterior resection for rectal cancer with the double staple technique, closing the rectum with a linear stapler in the abdomen can be challenging, especially when dealing with a narrow pelvis. For such instances, we propose the following modification to this technique: pull the rectal stump through the anus and perform an extra-anal resection of the tumor and a linear suture of the rectal stump before performing a standard, stapled colorectal anastomosis. The purpose of this study was to assess the adequacy of this modification of the double staple technique. Methods. Retrospective review of 108 patients that underwent stapled, low colorectal or coloanal anastomosis after eversion, extra-anal resection of a colorectal cancerous tumor and linear closure of the rectal stump, from January, 1990 to December, 2012. Results. The operative mortality was 0.9%. Fourteen patients (13%) presented early surgery-related complications, including seven anastomotic leaks, five wound infections, one ureteral lesion and one peristomal abscess. Late complications related to surgery included five incisional hernias (4.6%), four anastomotic strictures (3.7%), four neurogenic bladders (3.7%) and two fecal incontinences (1.8%). The incidence of local disease recurrence was 10%. Conclusions. Surgical and oncological results validate the proposed modification of the double staple technique when facing difficulties in suturing the rectum from within the abdomen.