[Background] Transection and anastomosis of the rectum in the narrow pelvic cavity might be challenging in the laparoscopic colorectal surgery and we do not have easy, secure and consistent standard method to avoid post-operative complications. In fact, in the literatures published after the year of 2005, anastomotic leakage occurred in 6.4-13.5% of the patients. At the previous 2008 SAGES meeting, we have revealed the feasibility and efficacy of double TA transection method comparing with IO transection by Endo-staplers. In this study, we report the updated results of this kind of technique.
[Patients and methods] Between January 2005 and August 2009, we operated laparoscopically twenty-six patients of middle or low third rectal cancer with this method. One colorectal surgeon performed all operations, and all anastomosis were done in DST fashion. In this method, transection of the rectum was performed 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.
[Results] Patients characteristics were as follows, mean age; 66.6 years old, male:female; 9 : 17, high : low resection; 14 : 12. Mean operating time was 212.5 minutes (range, 120-285) and mean blood loss was 99.6 ml (range, 30-400). Mean post-operative hospital stay was 13.1 days (range, 8-16). Throughout this study, we encountered no wound infection as well as anastomotic leakage.
[Conclusion] At this moment, this method might provide secure and uniform transection and anastomosis in the laparoscope-assisted surgery for rectal cancer. The advantage of this method seems to be the point that full length stapling of the rectum could be done certainly by single stapler handling under the magnified view of the laparoscope maintaining pneumoperitoneum.
Program Number: P108