Experience with the Use of the Surgical Staplers in Rectal Cancer Surgery.
- Author:
Jin Cheon KIM
1
;
Hee Won CHUNG
;
Chang Sik YU
;
Han Il LEE
;
Sang Gyu PARK
;
Myung Sik HAN
;
Kun Choon PARK
Author Information
1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Korea.
- Publication Type:Original Article
- Keywords:
Surgical stapler;
Rectal cancer
- MeSH:
Anastomotic Leak;
Constriction, Pathologic;
Dilatation;
Female;
Gastrointestinal Hemorrhage;
Humans;
Laxatives;
Medical Errors;
Rectal Neoplasms*;
Recurrence;
Surgical Instruments;
Surgical Staplers*;
Surgical Stapling
- From:Journal of the Korean Surgical Society
1997;53(3):377-384
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The surgical stapling technique has been recognized as an indispensable tool in rectal cancer surgery. A personal experience in one-hundred patiens is presented for the purpose of appropriate use of the surgical staplers. Three anastomotic techniques used were end-to-end anastomosis in 75 cases, double-stapling in 11 cases, and side-to-end anastomosis in 14 cases. In 88 cases, level of anastomosis was below the peritoneal reflection. Eight cases of stapling errors were found during operation. Among them, 5 cases of instrumental failure were 2 cases of blade defect and each one of difficult extraction, misfiring or tearing over trocar. The other 3 cases of surgical errors come from uneven perirectal excision causing one incomplete doughnut and 2 deficient anastomosis. Distal resection margin was closely related to the location of tumor(p < 0.01), but local recurrence did not associated with it. Two cases of postoperative hematochezia showed self-limiting. Anastomotic leakage occurred in 3 female patients and they were converted into resection. Excluding one leakage from skipped proximal foci, 2 cases occurred in the ultra-low anastomosis. Postoperative stricture was found in 5 cases and they were not associated with internal diameter of circular stapler. They were treated by manual dilatation and bulk-forming laxatives without surgical intervention. Bowel frequency or inability of deferrment was found in 9 cases on 1 month and 5 cases on 6 months postoperatively. They were not related to anastomotic level or stapling method. In conclusion, the stapling technique in rectal cancer surgery is a safe as well as a comfortable technique whenever complication can be amenable to the surgeon.
