Comparison of Four Methods of Transection and Anastomosis in the Laparoscope-Assisted Anterior Resection of the Rectum

Fumihiro Uchikoshi, MD PhD, Tsukasa Oyama, MD PhD, Takahiko Tatsumi, MD PhD. Department of Surgery, Tatsumi clinic & Hospital


 [Background] Even in the up to date laparoscopic surgery of the rectum, we do not have standard method of transection / anastomosis to avoid post-operative leakage. In fact, in the literatures published after the year of 2005, anastomotic leakage occurred in 6.4-13.5% of the patients. In this study, we chronographically tried four methods to find out the best way to do safe and effective laparoscopic surgery for rectal cancer.
[Patients and methods] Between April 1993 and September 2011, we operated one hundred and five patients of rectal cancer laparoscopically. Eighteen patients converted to open surgery were excluded from this study. Two colorectal surgeons performed all operations, and all anastomosis were done in DST fashion. During this period, we tried following four methods; A) Transection using staplers designed for open surgery (Access55) under the direct vision from small mid-line incision (8 cases), B) Transection using staplers designed for laparoscopic surgery (ex. Endo-GIA or Endocutter) (49 cases), C) Transection using staplers designed for open surgery (ex. TX30G or TA45) inserted through Lap disk (Hakko, Inc. Tokyo Japan), which was abdominal wall sealing device attached to 5 cm pfannenstiel incision (26 cases). D) Transection using next-generation linear staplers (ex. Endo-GIA Tri-Staple) designed for laparoscopic surgery (4 cases)
[Results] There was no significant difference in age, gender, operative time and the level of rectal transection between the four groups. We encountered no anastomotic leakage in method A, C and D, but seven cases in method B (14.3%) were suffered from this major complication. The length of hospital stay was the shortest in group C.
[Conclusion] The advantage of method C seems to be the point that full length stapling of the rectum could be done certainly at once under the magnified view of the laparoscope maintaining pneumoperitoneum. To avoid making an additional wound for inserting staplers, method D might be ideal to perform secure and uniform transection / anastomosis at this moment.

Session Number: Poster – Poster Presentations
Program Number: P056
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