COLORECTAL ANASTOMOSIS WITH THE DOUBLE STAPLE TECHNIQUE.
R. Khoo MD; J. Langevin MD; D. Jenken MD.
Denver, CO and Calgary, Canada.

Between 1988 and 1992, 144 patients (71 males, 73 females, mean age 63 years) were subjected to a double staple anastomosis after resection of a rectal or sigmoid lesion. Indications for surgery were: cancer/polyp - 14 patients, diverticultis -13 patients, closure of Hartmann - 9 patients, endometriosis - 4 patients, rectal prolapse - 2 patients, stricture - 1 patient, carcinoid - 1 patient. Twelve patients had preoperative chemo-radiation therapy. The level of the anastomosis was <7 cm in 34 patients, and >7 cm in 110 patients. The anastomosis was suture reinforced in 49 patients. Drains were used in 111 patients.

Intraoperative testing of the anastomosis revealed 4 leaks. One was successtully repaired without fecal diversion. In the other three patients the defect could not be repaired, so a loop ileostomy was brought out. The ileostomies were later closed and all three anastomoses healed.

Postoperative anastomotic complications were noted in only 5 patients. There was one clinical leak in the entire series (0.7 percent) and this resulted in sepsis and death The other 4 patients developed a stricture. In three patients the stricture was dilated as an outpatient with resumption of normal function. One patient had severe narrowing which required a defunctioning colostomy. None of those subjected to preoperative radiation experienced an anastomotic leak or stricture. In addition, the anastomotic complication rate was not influenced by the level of the anastomosis, the use of drains, or the use of suture reinforcement.

The double staple anastomosis is safe and associated with a low complication rate, even in the presence of preoperative radiation therapy.

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