Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 28, 2013; 19(32): 5309-5313
Published online Aug 28, 2013. doi: 10.3748/wjg.v19.i32.5309
Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy?
Se-Jin Baek, Jin Kim, Jungmyun Kwak, Seon-Hahn Kim
Se-Jin Baek, Jin Kim, Jungmyun Kwak, Seon-Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea
Author contributions: Baek SJ mainly contributed to this paper; Kim J edited the paper; Kwak J and Kim SH reviewed the paper generally.
Correspondence to: Jin Kim, MD, PhD, Department of Surgery, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, South Korea. mrgs@korea.ac.kr
Telephone: +82-2-9205346 Fax: +82-2-9281631
Received: April 10, 2013
Revised: June 16, 2013
Accepted: July 18, 2013
Published online: August 28, 2013
Processing time: 139 Days and 2.3 Hours
Abstract

AIM: To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution.

METHODS: The data of patients who received trans-anal reinforcing sutures were compared with those of patients who did not receive them after low anterior resection. Patients who underwent laparoscopic low anterior resection and the double-stapled anastomosis technique for primary rectal cancer between January 2008 and December 2011 were included in this study. Patients with no anastomosis, a hand-sewn anastomosis, high anterior resection, or preoperative chemoradiation were excluded. The primary outcomes measured were the incidence of postoperative anastomotic complications and placement of a diverting ileostomy.

RESULTS: Among 110 patients, the rate of placement of a diverting ileostomy was significantly lower in the suture group (SG) compared with the non-suture control group (CG) [SG, n = 6 (12.8%); CG, n = 19 (30.2%), P = 0.031]. No significant difference was observed in the rate of anastomotic leakage [SG, n = 3 (6.4%); CG, n = 5 (7.9%)].

CONCLUSION: Trans-anal reinforcing sutures may reduce the need for diverting ileostomy. A randomized prospective study with a larger population should be performed in the future to demonstrate the efficacy of trans-anal reinforcing sutures.

Keywords: Anastomotic leak, Low anterior resection, Rectal neoplasms, Double-stapled anastomotic technique, Reinforcement sutures

Core tip: We have performed trans-anal reinforcing sutures after the double-stapled anastomotic technique to intensify the anastomotic line and to reduce leakage. As a result, we found that the rate of placement of a diverting ileostomy was significantly reduced in cases of performing the trans-anal reinforcing sutures although there was no significant decrease of anastomotic leakage.