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CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(04): 286-289
DOI: 10.1055/s-0042-1757771
Original Article

Impact of the Vertical Division of the Rectum on the Decrease in Reloading of the Endostapler for a Complete Division in Colorectal Cancer

Yasser A. Debakey 
1   Department of Surgical Oncology, National Cancer Institute of Cairo University, Cairo, Egypt
,
Amr A. Nofal
1   Department of Surgical Oncology, National Cancer Institute of Cairo University, Cairo, Egypt
,
Sayed S. Sheier
1   Department of Surgical Oncology, National Cancer Institute of Cairo University, Cairo, Egypt
,
Ayman A. Hanafy
1   Department of Surgical Oncology, National Cancer Institute of Cairo University, Cairo, Egypt
,
Abdalwahab R. Abdalwahab
1   Department of Surgical Oncology, National Cancer Institute of Cairo University, Cairo, Egypt
,
Tarek M. Hashem
1   Department of Surgical Oncology, National Cancer Institute of Cairo University, Cairo, Egypt
,
Sara I. Albastaki
2   Department of Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Abstract

Background Despite several improvements in surgical techniques, the intracorporeal division of the distal end of the rectum is still challenging, particularly when it is too deep in a narrow pelvis. Even though it helps avoid spillage, the double-stapling technique (DST) raises concerns regarding safety and anastomotic leakage if multiple stapler firings are essential to complete the rectal division.

Objective To assess the feasibility of vertically dividing the rectum and its impact in reducing the number of reloads essential for that division in non-low rectal cancer patients undergoing total mesorectal excision (TME).

Materials and Methods A retroprospective study.

Results From January 2017 to November 2021, a total of 123 patients with sigmoid and rectal cancers were enrolled in the present study; their data were collected and analyzed, and 21 patients were excluded. The remaining sample of 102 subjects was composed of 47 male (46%) and 55 female (54%) patients with a median age of 54 years (range: 30 to 78 years). Only 1 reload was enough to complete the rectal division in 82 (80.39%) cases, and 2 reloads were used in the remaining 20 (19.61%) patients. Anastomotic leakage was clinically evident in 4 cases (3.9%). No statically significant difference was observed when firing one or two staplers. No 30-day mortality was recorded in this series.

Conclusion Our early experience indicates that this type of division has a real advantage in terms of decreasing the number of reloads needed and, in turn, lowering the incidence of anastomotic leakage after partial mesorectal excision (PME) or TME when applied with proper patient selection.

Keywords

rectal cancer - vertical division


Publikationsverlauf

Eingereicht: 10. März 2022

Angenommen: 15. September 2022

Artikel online veröffentlicht:
22. Dezember 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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