A NEW DEVICE FOR THE TREATMENT OF COLOPROCTOSTOMIC STRICTURE AFTER DOUBLE STAPLING ANASTOMOSES

Objective A new device of staple cutter was developed to evaluate the clinical effect for the treatment of rectal stricture after the double stapling anastomosis. Summary Background Data The double stapling tec hnique has become an established reconstruction method for patients wi th low anterior resection. The major complication of anastomotic stric ture associated with circular stapling has been reported to be harmful and distressing. Because underlying mechanisms of stricture are not w ell understood, no prophylactic means have been developed and this res ults in postoperative dilation still being the only treatment availabl e. Although various dilation methods are used for the treatment of str icture, none is fully satisfactory. Methods Low anterior resection was performed in 30 patients with rectal carcinoma using a double staplin g technique. First, the incidence of the anastomotic stricture and the clinical factors that contribute to the stricture formation were stud ied. Second, the clinical effects and advantages of the treatment of c oloproctostomic stricture using the newly developed device (staple cut ter) were evaluated. Results Nine (30%) of 30 patients had anastomotic stricture with the symptom of distressing frequent bowel movement. Th ere was no significant relation between the clinical factors and the s tricture when compared with that of nonstricture patients. Excellent d ilation was performed in all of the nine strictures using the staple c utter, and the symptom of stricture disappeared dramatically in eight patients (89%) within 1 week. The recurrence of stricture occurred in two patients; however, it has not been observed after one further use of this treatment. The staple cutter is safe and easy to use even at t he bedside, and except for a conventional anoscope, no special equipme nt, including fluoroscope, was needed. Conclusions From the significan t effects and advantages, the procedure using staple cutter is recomme nded highly for the treatment of circular stapling anastomotic strictu re of the rectum.