Hidekazu Takahashi, MD, PhD, Kazuhiro Saso, MD, Norikatsu Miyoshi, MD, PhD, Naotsugu Haraguchi, MD, PhD, Taishi Hata, MD, PhD, Chu Matsuda, MD, PhD, Hirofumi Yamamoto, MD, PhD, Tsunekazu Mizushima, MD, PhD, Yuichiro Doki, MD, PhD, Masaki Mori. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine
Background: The double stapling technique (DST) has widely spread colorectal anastomosis especially for anastomosis after low anterior resection. As for the colorectal cancer treatment, Heald reported total mesorectal excision (TME) in 1982, and has been accepted as the standard technique for rectal resection due to the decreased local recurrence rate and improved functional results. With advent of DST, there is a background that it has become possible to preserve anus, even in the case with the lesion at lower rectum. Laparoscopic surgery for colon cancer was introduced in the 1990s, and has had promising results including long-term outcomes. According to the spread of laparoscopic surgery, laparoscopic surgery had been applied to the rectal resection, with technical difficulty. One of the reasons for the difficulty is that the high rate of anastomotic leakage, a critical adverse effect of low anterior resection (LAR). Thus, risk factors for anastomotic leakage were widely discussed, including technical factors such as pre-compression and number or firing. The decisive difference in conventional LAR and laparoscopic LAR in DST, is the stapler used for transection of the rectum. The laparoscopic staplers which are currently available are thought to be not ideal, and there is little evidence of specific specifications of stapler for laparoscopic surgery.
Materials and Methods: All method described in this study was approved by the institutional ethical review committee. We reviewed the colon and rectal wall thickness according to histological examination using H&E staining of distal margin of resected specimen of the patients who underwent surgery for left-sided colorectal cancer from April, 2016 to March 2017 (n = 77). For clinical experience, we performed 23 laparoscopic surgeries for left sided colorectal cancer using laparoscopic surgery use high-height staple stapler (Powered Echelon Flex GST® 60mm loaded with black cartridge, closed staple height 2.3mm), followed by DST using circular stapler.
Results: Average entire wall and muscularis thickness of resected specimen were 2.93mm (95% confidence interval (CI), 2.57-2.93), and 1.56mm (95% CI, 1.36-1.78). Since two intestinal walls overlap during rectal transection, we chose the high-height staple stapler in clinical cases. No remarkable adverse event using high-height stapled stapler, including misfiring, bleeding from stump, and anastomotic leakage in clinical cases.
Summary: Although, among the techniques that are currently available, transection of rectal stump by laparoscopic surgery was feasible, rectal closure with laparoscopic stapler with high-height staple seemed to be a potentially useful option for laparoscopic LAR.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86878
Program Number: P237
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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