SINGLE AND DOUBLE STAPLED ANASTOMOSES IN RECTAL-CANCER SURGERY - A RETROSPECTIVE STUDY ON THE SAFETY OF THE TECHNIQUE AND ITS INDICATION

Low anterior resection is commonly believed the main indication to dou ble stapled (DS) technique, because placing the purse-string suture on the distal rectum is difficult or impossible. This study was designed to figure out the safety of the DS technique and to better define its role in rectal cancer surgery. The data of 34 patients that had a DS anastomosis were retrospectively compared to those of 43 that had a si ngle-stapled (SS) anastomosis after anterior resection. Three deaths a fter SS (7%) and one after DS procedures (3%) were recorded (p = 0.62) . Rates of clinical leaks were 12% (four cases) in the DS group and 14 % (six cases) in the SS group (p = 0.41). The mean distance of the rec tal tumour from the anal verge was significantly lower for DS (mean = 7.7 cm) respect to SS (mean = 12.7 cm) anastomoses (p < 0.0001) and th e blood consumption at surgery was significantly greater in patients t hat had DS (mean = 375 ml) compared to SS-anastomoses (mean = 180 ml) (p = 0.028). Thus, the DS technique was mostly used in patients at hig h risk for leakage. The study shows that DS technique is a safe and re liable method to perform colorectal anastomosis after anterior resecti on for cancer. For cancers located in the upper rectum the routinary a doption of the DS increases the cost of surgery and does not offer adv antages over the SS technique with the exception of making feasible en d-to-end mechanical anastomoses involving bowel segments having differ ent diameters.