Laparoscopic intersphincteric resection for low rectal cancer: comparison of stapled and manual coloanal anastomosis

• Published in: Colorectal disease Vol. 16; no. 5; pp. 353 - 358
• Main Authors: Cong, J. C., Chen, C. S., Ma, M. X., Xia, Z. X., Liu, D. S., Zhang, F. Y.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-05-2014
• Subjects: Adult; Aged; Anal Canal - pathology; Anal Canal - physiopathology; Anal Canal - surgery; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Anastomotic Leak - etiology; Colon - pathology; Colon - physiopathology; Colon - surgery; Constriction, Pathologic - etiology; Female; Gastrointestinal Hemorrhage - etiology; hand-sewn coloanal anastomosis; Humans; Laparoscopic intersphincteric resection; Laparoscopy; low rectal cancer; Male; Middle Aged; Rectal Neoplasms - surgery; Rectovaginal Fistula - etiology; Retrospective Studies; stapled coloanal anastomosis; Surgical Stapling - adverse effects; Surveys and Questionnaires; low rectal cancer; Laparoscopic intersphincteric resection; hand-sewn coloanal anastomosis; stapled coloanal anastomosis
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.12573

Aim
The study aim was to analyse the safety and feasibility of laparoscopic intersphincteric resection with stapled coloanal anastomosis for low rectal cancer.
Method
Between March 2009 and August 2010, 22 patients underwent laparoscopic intersphincteric resection with a stapled coloanal anastomosis without a diverting ileostomy. The results were compared retrospectively with hand‐sewn coloanal anastomoses performed between January 2001 and May 2009, which included 55 open and 38 laparoscopic intersphincteric resections. The morbidity comparison only included data relevant to the anastomosis. Function was compared using the Saito function questionnaire and the Wexner score and only involved data relevant to the laparoscopy.
Results
The anastomotic complication rates were similar for fistula, bleeding and neorectal mucosal prolapse (P = 0.526, P = 0.653 and P = 0.411, respectively). Anastomotic leakage and stricture formation of the stapled coloanal anastomosis were significantly lower than those of the hand‐sewn coloanal anastomosis (P = 0.037 and P = 0.028, respectively). There were no significant differences in the Saito function questionnaire and the Wexner score between the stapled and hand‐sewn coloanal anastomotic groups (all P > 0.05).
Conclusion
Laparoscopic intersphincteric resection with a stapled coloanal anastomosis is technically feasible and is less likely to result in anastomotic leakage and stricture formation than a hand‐sewn anastomosis.