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KMID : 0978820070100010017
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2007 Volume.10 No. 1 p.17 ~ p.21
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The Safety of Plicated Colo-anal Anastomosis after Laparoscopic Ultra-low Anterior Resection: A Pilot Study
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Choi Gyu-Seog
Lee In-Taek
Jo Min-Jung
Jun Soo-Han
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Abstract
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Purpose: Colo-anal anastomosis after ultra-low anterior resection is technically demanding and it has a high risk of complication. Therefore, most surgeons prefer to create a protective stoma for this procedure. We developed a new technique of colo-anal anastomosis for laparoscopic ultra-low anterior resection, and we evaluated the safety of this technique.
Methods: From March to September 2005, we performed hand-sewn colo-anal anastomosis after laparoscopic ultra-low anterior resection for the treatment of ten patients suffering with low lying rectal cancer. There were 7 male and 3 female patients with the mean age of 61.5 years. The mean level of tumor was 3.7 cm above the anal verge. After full mobilization of the left colon and rectum, the rectum was divided at the dentate line from the perineal side. The specimen was brought out through an abdominal mini-incision and the distal end of the proximal colon was everted 1 cm in length and sutured, the mucosa of the proximal colon was peeled off. The anastomosis was then made by using 3-0 PDS in a Gambee fashion through the anus.
Results: The mean operating time was 285 minutes. Patients could resume their diet at postoperative 7 days and the mean duration of the postoperative hospital stay was 11.8 days. Open conversion or protective stoma was not necessary. There was no anastomosis leakage or operative mortality.
Conclusion: Plicated colo-anal anastomosis was a safe technique and it can avoid creating an unnecessary protective stoma after laparoscopic ultra-low anterior resection for the treatment of low lying rectal cancer.
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KEYWORD
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Laparoscopic low anterior resection, Plicated colo-anal anastomosis, Safety
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