Triple-Staple Technique Effectively Reduces Operating Time for Rectal Anastomosis

Abstract

Purpose Stapled anastomotic techniques to the distal rectum have gained widespread acceptance due to their procedural advantages. Various modifications in the stapling techniques have evolved since their inception. The triple-staple technique utilizing stapled closure of both the proximal colon and distal rectal stump provides a rapid and secure colorectal anastomosis. The aims of this study are to determine the safety and efficacy of the triple-staple technique, and to compare the clinical outcomes with a historical control group for which the conventional double-staple technique had been performed. Methods One hundred consecutive patients operated on by a single surgeon were included, 50 patients who underwent double-staple (DSA), then 50 triple-staple anastomoses (TSA). Results The most common indication for surgery in both groups was rectal cancer followed by diverticular disease and distal sigmoid cancer. There was no significant difference in the number of covering loop ileostomy formation in both groups (TSA 56% vs DSA 68%; p=0.621). The mean operating time for the TSA group was significantly shorter compared to the DSA group (243 vs 306 minutes; p=0.001). There was no significant difference in complication rates (TSA 40% vs DSA 50%; p=0.315) and length of hospital stay between the two groups (TSA 11.3 vs DSA 13.0 days, p=0.246). Post-operative complications included anastomotic leak, prolonged ileus, bleeding, wound infection and pelvic collection. Conclusion The triple-staple technique is a safe alternative to the double-staple anastomosis after anterior resection. It also effectively shortens the operating time.

Effort to Improve Rectal Anastomosis: the Triple-Stapled Technique for Rectal Anastomosis

“…Concerns regarding the size disparity between the proximal colon and the rectal stump could also be more easily addressed in TSA than in DSA. In addition, the operative time was decreased for TSA compared to that for DSA, due to the elimination of the pursestring suture procedure (mean of minutes, TSA vs. DSA: 242.8 vs. 306.1, P = 0.001) [7]. However, the key factors associated with successful colorectal anastomoses, such as anastomotic leakage rate and incidence of other complications, did not differ between TSA and DSA in the current study.…”

“…They asserted that the additional cost was offset by the shortened operative and anesthesia time. In the current study, the authors justified the additional cost of TSA in the same way [7]. However, since the situation is different in Korea, where medical expenses are relatively lower than those in the United States, I have doubts about that.…”

“…Some surgeons are concerned that this process increases the risk of contamination at the surgical site. Moreover, it is difficult to achieve closure via the pursestring method when the colon is dilated or edematous [7]. Along with the aforementioned reasons, foreign body reactions caused by metal stapling may negate the advantages of stapling and be associated with the non-superiority of stapled over hand-sewn anastomosis.…”

“…The current study concerns the triple-stapled anastomosis (TSA) technique for colorectal anastomosis [7]. To the best of my knowledge, TSA in colorectal anastomosis was introduced in 1989 [8].…”

Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version

“…The primary objective of cancer surgery is to enhance survival and quality of life while minimizing side effects [3]. To improve colorectal cancer treatment with respect to functional, oncological, surgical, patient-reported, and financial outcomes, advancements in surgical procedures are essential [3][4][5][6][7].…”