Use of the End to End Anastomotic Stapler From Above for Difficult Pelvic Surgery for Distal Rectal Disease

Abstract

Introduction Transabdominal utilization (TAU) of the end to end anastomotic (EEA) stapler in low anterior resection (LAR) for rectal cancer is an excellent alternative to the most widely performed techhnique. Methods We performed a retrospective analysis of a prospectively maintained database which obtained data on 104 patients with rectal disease who underwent EEA-assisted LAR with TAU. Records of all patients were used to evaluate demographics, complications, tumor location, margin status, postoperative complications, clinical sphincter function, adjuvant or neoadjuvant treatment, disease stage, and survival. Results Of the 104 patients, 48% were women with a mean age of 64 years (range 34-85 years). The average tumor location was 8 cm above the dentate line, and the mean tumor distance from the distal margin was 1.9 cm. All distal margins in cases for patients with rectal cancer were negative. Hospital length of stay averaged 8.7 days (6-15 days). There were no anastomotic complications (leaks, bleeding, or obstruction), and there were no leaks at the separate colotomy site. All patients have had normal postoperative sphincter function. Conclusion Transabdominal utilization of the EEA stapler in LAR for colorectal carcinoma is an alternative to the conventional approach and may be advantageous in avoidance of the lithotomy position with potential nerve injury, risk of deep venous thrombosis, and stapler-induced sphincter trauma.