The use of single-stapling techniques reduces anastomotic complications in minimal-invasive rectal surgery

Abstract

Background Leakage of rectal anastomoses is one of the most important and feared complications in colorectal surgery. Apart from patient-specific risk factors, technical aspects may influence the occurrence of anastomotic complications. This study investigated whether using single-stapling techniques (SST) instead of the double-stapling technique (DST) for minimal-invasive rectal anastomosis is associated with a lower rate of anastomotic complications. Methods A retrospective review of 272 patients who received a minimally invasive stapled rectal anastomosis (3–16 cm from the anal verge) at our institution from 2015 to 2020 was performed. In 131 patients, rectal anastomosis was created by SST (SST group), while 141 patients received a rectal anastomosis with crossing stapler lines (DST group). The impact of the anastomotic technique on patient outcomes was determined by uni- and multivariate analyses. Results Overall anastomotic leakage rate was 6%. Patients with SST anastomoses had a lower leakage rate than patients with DST anastomoses (3% vs. 9% in the DST group, p = 0.045). The rate of anastomotic stenosis was lower in the SST group than in the DST group (1% vs. 6%, p = 0.037). Overall morbidity and mortality did not differ between the two groups. Multivariate analysis showed that single-stapling techniques significantly reduce the risk of anastomotic leakage (OR 3.5 [1.0–11.5], p = 0.043). Conclusion The use of SST for rectal anastomosis may help to reduce anastomotic complications. This finding should be confirmed by a randomized controlled trial.

Omega suture technique for minimally invasive rectal anastomosis – a video vignette

“…A retrospective analysis of our patient cohort has revealed a significantly lower rate of anastomotic leakage and stenosis following minimally invasive colorectal resections with a single-stapling technique including the presented technique with an omega suture compared with those with the classical double-stapling technique [4]. However, randomized controlled trials are needed to confirm these findings.…”

“…Preservation of the sphincter complex and continence is another advantage of LE for early rectal cancers. However, there are some criteria that should be met before choosing patients for TAMIS; in addition to the tumour being of low risk T1N0 and occupying <30% of the rectal circumference, the distance from the anal verge has important implications in the technical feasibility of the procedure, with the optimal range from the anal verge being 5-18 cm [4].…”

The Colorectal Anastomosis: A Timeless Challenge

“…Unlike the purse-string technique, it avoids fecal spillage. A new retrospective review of DST versus SST, 101 comprising 30% classical and 70% omega suture, demonstrating a reduction in anastomotic leak from 9 to 3% ( p = 0.045) and stenosis from 6 to 1% ( p = 0.037) in favor of SST.…”

Fact or fiction? Does the position of the end‐to‐end (EEA) stapler spike matter for colorectal anastomoses using a double‐stapled technique?

“…Surgical textbooks, as well as manufacturer guidelines for commonly used circular EEA staplers, typically show the stapler spike piercing through the rectal transverse staple line before mating with the anvil, thereby resulting in up to two crossing staple lines and two "dog ears" on each side. Emerging data suggest that these crossing staple lines and the adjacent "dog ears" are potential weak points that are prone to ischaemia and anastomotic leak [1,2]. In fact, on 7 October 2021, the Food and Drug Administration released a letter to healthcare providers warning of risk of "increased leak rates when staple lines are crossed, even if there may be clinical circumstances when a surgeon may deem it necessary" [3].…”