Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan.
Surg Endosc. 2010 Sep;24(9):2178-81. doi: 10.1007/s00464-010-0921-5. Epub 2010 Feb 23.
Double stapling technique (DST) is a physiological end-to-end anastomosis that is currently used widely in rectal surgery and also in sigmoidectomy. In laparoscopy-assisted sigmoidectomy, we occasionally encounter obstruction during insertion of the circular stapler device from the anus. In such cases, we used to cut the residual rectosigmoid colon additionally and to allow DST anastomosis. Here, we propose an alternative way to overcome this difficulty, that is to perform an anastomosis to the anterior wall of the rectosigmoid colon.
Between 2001 and 2007, we experienced the cases of 10 sigmoid colon cancer patients who underwent laparoscopic surgeries with a conversion from DST to end to side (anterior wall) anastomosis.
None of the patients suffered from anastomosis leakage, and none had complained of their stool habits. Colonoscopy showed that anastomosis window is kept wide and that stool is not pooled in the blind pocket of the rectosigmoid colon, suggesting the passage is well preserved.
Our experience indicates that though several technical points should be noted, an end to anterior wall anastomosis procedure is easy and safe. This method is a useful alternative way when end-to-end DST anastomosis is not performed smoothly in laparoscopic surgery.
双吻合技术（DST）是一种生理的端端吻合术，目前广泛应用于直肠手术和乙状结肠切除术。在腹腔镜辅助乙状结肠切除术中，我们偶尔会在从肛门插入圆形吻合器装置时遇到梗阻。在这种情况下，我们通常会额外切断残余的直肠乙状结肠，并允许进行 DST 吻合。在这里，我们提出了一种替代方法来克服这一困难，即进行直肠乙状结肠前壁吻合术。
在 2001 年至 2007 年间，我们共治疗了 10 例乙状结肠癌患者，这些患者在腹腔镜手术中因 DST 转为端侧（前壁）吻合术而进行了转换。
没有患者发生吻合口漏，也没有患者抱怨他们的排便习惯。结肠镜检查显示吻合口保持宽阔，粪便不会在直肠乙状结肠盲袋中积聚，表明通道保持良好。
我们的经验表明，尽管需要注意一些技术要点，但端到前壁吻合术是简单且安全的。当腹腔镜手术中不能顺利进行端端 DST 吻合时，这种方法是一种有用的替代方法。
