Feasibility and Impact on Surgical Outcomes of Modified Double-Stapling Technique for Patients Undergoing Laparoscopic Anterior Resection

Abstract

Our comparative study demonstrates MDST to have better short-term outcome in reducing anastomotic leakage compared with DST. This technique could be an alternative approach to maximize the patients' benefit in laparoscopic anterior resection.

Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis

“…Of these, 198 were excluded after scanning titles and abstracts, leaving 31 citations for full text assessment. Of these, 14 studies met the inclusion criteria and were used for this meta-analysis [11][12][13][14][18][19][20][21][22][23][24][25][26][27]. The remaining studies were excluded largely because they did not reported the incidence of AL according to the factors we evaluated; or were not focused on AL after laparoscopic resection, but open surgery; or were overlapping data reported in other studies.…”

“…Six studies investigated the relationship between ASA score and risk of AL [12,13,18,20,21,23]. The AL rate was 5.8 % in patients with ASA score B2 and 9.3 % in patients with ASA score [2.…”

“…From the eight studies examining the effect of tumor size [11,13,21,23,24,27], AL was present in 8.3 % of the patients with tumor diameter [5 cm compared to 4.9 % of the patients with tumor size B5 cm. The pooled analysis showed that the risk of AL was significantly higher in the cases of tumor size [5 cm (OR 1.63, 95 % CI 1.01-2.64, P = 0.05).…”

A novel single-stapling technique for colorectal anastomosis: a pre-ligation single-stapling technique (L-SST) in a porcine model

“…Modified DST is reported to be a safer anastomotic technique than conventional DCT [16]. However, these methods demand suturing during laparoscopic surgery, which is very difficult, especially in the narrow pelvic area.…”

“…However, these methods demand suturing during laparoscopic surgery, which is very difficult, especially in the narrow pelvic area. In fact, in the reported study, a Pfannenstiel skin incision was made to apply the stitches in the pelvic cavity using hand sutures under direct vision because of technical difficulties [16]. During robotic surgery using the da Vinci surgical system, for example, the operator is able to use articulating laparoscopic instruments with wrist motions that make suturing and knot Fig.…”