Retrospective analysis of rectal stenosis after anterior resections with or without stapling: rectal stapling is not a “thornless rosary”

Recently, stapler anastomosis is the method of choice in low or ultra low resection for rectal carcinoma. In this study, risk of rectal stricture formation after double stapling colorectal anastomosis was evaluated. We here with presented an invitro investigation and a retrospective analysis of 91 cases of rectal carcinoma treated by low or ultra low anterior resection with hand-sewn or double-stapled colorectal anastomosis between the years 2002-2006 regarding the late complication of postoperative stenosis. In in vitro investigation external and internal diameters of staplers were measured. Also diameters of anastomotic lines were investigated on stapled sheep intestine and low anterior resection specimen of human, in vitro. External and internal diameters of 29 and 33 mm staplers were found 19.5-24 mm respectively. Also diameters of anastomosis with 29 mm stapler at sheep intestine and 33 mm stapler at low anterior specimen were found 15 mm, 20 mm respectively.Rectal stricture was not seen in any of the patients with hand-sewn anastomoses. We found postoperative stricture of the rectal anastomosis in 11 (17.2 %) of the patients treated by double-stapled group (p=0.022). The risk factors that we have investigated were age and gender of the patient, location and stage of the tumour, diameter of EEA staplers, and presence of neoadjuvant or adjuvant chemoradiotherapy. Although double-stapling anastomosis in rectal cancers has clear technical advantages over hand-sewn technique, the late complication of stenosis occurred at a significantly higher rate after this technique.