A Clinical Study of Anastomosis in the Reconstruction for Anterior Resection of the Rectum and Sigmoidectomy -An Efficacy of Double Stapling Technique-

Tsutomu Tagawa, Yuuji Oota, Yuusuke Nakano, Takeshi Nagayasu, Akira Adachi

Department of Surgery, Tagawa Municipal Hospital

We analyzed 14 cases of anterior resection, one case of trans-sacral resection of the rectum and 11 cases of sigmoidectomy with partial resection of the rectum. They were performed between January 1983 and August 1990. The methods of anastomosis used in these operations were the double stapling technique (DST) in 15 patients, the single stapling technique in one and hand suture in 10. The sites of anastomosis were as follows; for DST, high in eight cases, low in five cases and super low in two cases; for hand sutute, high in six cases and low in four cases. In low and super low cases, the mean distance of the tumor from the anal verge was 11.7±5.4 cm for DST and 11.0±0.8 cm for hand suture. The mean distance of the anastomosis from the anal verge was 5.9±2.5 cm for DST and 8.7±0.7 cm for hand suture (p<0.05). The mean operating time was 212.5±52.5 minutes for DST and 296.0±42.5 minutes for hand suture (p<0.05). In all cases, complications from the operations were leakage in one patient and bleeding in another for DST and an abscess on the abdominal wall in two and mild stenosis in one patient for hand suture. We classified four types of anastomosis with DST. End to end type I and end to end type II are preferrable, because in these types the linear stapler is cut by the circular stapler at the adequate site. End to side type I has propensity for ischemia where two staplers meet and is not recommended. End to side type II was performed only in the secondary reconstruction with DST following Hartmann's operation. In Hartmann's operation, the distal rectum had been cut with a linear stapler, while in the secondary operation, a circular stapler served as a stent for the anal end of the rectum and made the operation easily. Reconstruction with DST could be applied to high anterior resection and sigmoidectomy with partial resection of the rectum. And it was effective for lower tumors, require shorter time for operation and produce fewer complications in low anterior resection of the rectum.

Key words
rectum, anterior resection, double stapling technique, hand suture, Hartmann's operation

Reprint requests
Tsutomu Tagawa Department of Surgery, Tagawa Municipal Hospital
2-2 Chuoh-cho, Tagawa, 825 JAPAN

Accepted
July 6, 1992

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