Ligation of the Rectum with an Extracorporeal Sliding Knot Facilitating Laparoscopic Cross-Stapling: A Procedure Revisited

Abstract

Abstract

Background:

Multiple stapler firings during distal rectal division were associated with unduly long stapler line and anastomotic leakage after laparoscopic rectal resection. A simple and relatively easy technique to perform a safe transection of rectum is presented.

Materials and Methods:

The extracorporeal ligation of the rectum just proximal to the cut end of the rectum before applying the linear stapling stapler facilitates the procedure and requires only a few firings of the stapler during the laparoscopic rectal resections.

Results:

Ten patients with a median age of 72 years underwent rectal transection with this technique. The procedure was performed with a single 60-mm cartridge in 3 patients, and two firings of the Endo GIA™ (Covidien LLC, Mansfield, MA) with a 45-mm cartridge were necessary for cross-stapling at the level of the pelvic floor in the remaining patients. There were no intraoperative complications. Postoperative complications were seen in 2 patients.

Conclusions:

This simple technique theoretically seems safer than the conventional approach and should be considered as an additional option for rectal transection.