Mechanical Suture in Rectal Cancer

Abstract

Background and aimsColorectal cancer is one of the most frequent digestive malignancies, being the third cause of death by cancer, despite early diagnosis and therapeutic progress made over the past years. Standard treatment in these patients is to preserve the anal sphincter with restoration of intestinal function by mechanical colorectal anastomosis or coloanal anastomosis, and to maintain genitourinary function by preservation of hypogastric nerves.MethodsIn order to emphasize the importance of this surgical technique in the Fourth Surgical Clinic of the CF Clinical Hospital Cluj-Napoca, we conducted a prospective observational interventional study over a 3-year period (2013–2016) in 165 patients hospitalized for rectal and rectosigmoid adenocarcinoma in various disease stages, who underwent Dixon surgery using the two techniques of manual and mechanical end-to-end anastomosis. For mechanical anastomosis, we used Covidien and Panther circular staplers. The patients were assigned to two groups, group A in which Dixon surgery with manual end-to-end anastomosis was performed (116 patients), and group B in which Dixon surgery with mechanical end-to-end anastomosis was carried out (49 patients).ResultsMechanical anastomosis allowed to restore intestinal continuity following low anterior resection in 21 patients with lower rectal adenocarcinoma compared to 2 patients in whom intestinal continuity was restored by manual anastomosis, with a statistically significant difference (p<0.000001). The double-row mechanical suture technique is associated with a reduced duration of surgery (121.67 minutes for Dixon surgery with mechanical anastomosis, compared to 165.931 minutes for Dixon surgery with manual anastomosis, p<0.0001).ConclusionThe use of circular transanal staplers facilitates end-to-end anastomosis by double-row mechanical suture, allowing to perform low anterior resection in situations when the restoration of intestinal continuity by manual anastomosis is technically not possible, with the aim to preserve the anal sphincter, to restore intestinal function and maintain genitourinary function through preservation of hypogastric nerves.

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

“… 61 In comparison, Cheregi et al show a reverse trend, revealing incidence rates twice as high for the hand-suture anastomoses than for the stapler anastomoses. 54 However, the majority of the meta-analyses and clinical trials 51 , 56 , 60 , 64–66 as well as our assessment ( Table 1 ) show that both techniques cause similarly high incidence rates for these kinds of complications.…”

Risk of anastomotic leakage with two-row versus three-row manual circular staplers in colorectal anastomosis: a U.S. cohort study

“…The primary variations in the stapling mechanics of commonly used circular staplers include closed height of staples, mechanical vs. powered mechanism for firing staples, shape of final staple form, and number of rows of staples. Various preclinical and clinical studies have demonstrated the safety and efficacy of these devices [ 11 – 16 ], but there are relatively few head-to-head studies of different devices and no prospective trials.…”