The Relationship Between Number of Intersections of Staple Lines and Anastomotic Leakage After Double Stapling Technique in Laparoscopic Colorectal Surgery

Seunghun Lee, MD, Seunghyun Lee, MD, Byeonggwon Ahn, MD. Kosin University Gospel Hospital

INTRODUCTION: Laparoscopic intracorporeal colorectal anastomosis with double stapling technique (with linear and circular stapling devices) is difficult because of unsuitable cutting angle in narrow pelvic cavity. For reasons of tilted and long linear staple line of rectal stump, circular anastomotic plane can make multiple intersections of staple lines. The present study was designed to assess whether multiple intersections after double stapling technique is the risk factor of anastomotic complication in laparoscopic colorectal surgery.

METHODS AND PROCEDURES: 128 consecutive left colon and rectal cancer patients who underwent laparoscopic rectal resection with double stapling technique were enrolled in this study. In all cases, operator tried to reduce intersections by inversion technique (After introducing circular endostapler through the anus and opening integrated trocar of endostapler on the linear staple line, either one or both edge of linear staple line were folded and stuck into the integrated trocar to hide staple line inside the rim of the anvil). They were subdivided into three groups: 58 patients with no intersection of staple lines (Group A), 62 patients with 1 point of intersection (Group B) and 8 patients with 2 points of intersection (Group C). Intraoperative air leakage, incomplete cut ring, postoperative bleeding, anastomotic stenosis and leakage were compared between the three groups.

RESULTS: Clinical or radiologic apparent anastomotic leakage was identified in 1 (group C) of 128 patients (0.7 %). Overall anastomotic leakage rate was 0 % (0/58) in group A, 0 % (0/62) in group B and 12.5 % (1/8) in group C (p = 0.001). In univariate analysis, intersections of staple lines were associated with anastomotic complications. There were no statistically significant differences between three groups in multivariate analysis.

CONCLUSION: The number of intersections of staple lines is associated with anastomotic leakage and inversion technique is useful method of avoiding anastomotic leakage. Using an appropriate technique by skilled operator, double stapling technique for laparoscopic anterior resection is safe and feasible.

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