Illuminati Giulio, Krizzuk Dimitri, Pizzardi Giulia, Perotti Bruno, Pasqua Rocco, Urciuoli Paolo
Ann Ital Chir. 2019;90:78-82.
Anterior resection of the rectum with a total mesorectal excision is the standard surgical technique for the treatment of rectal cancer. Laparoscopic low anterior resection (LALAR) is an alternative to open surgical approach and was validated in diverse randomized control trials to be as safe and oncologically effective. That said, confronting a low rectal tumor in an obese patient with a narrow pelvis can be technically challenging even for the most expert surgeon.
We propose a modified double stapling technique with transanal eversion and staple resection of the rectal stump.
We applied the above technique in 3 patients with a dubious distal resection margin due to patient/tumor characteristics. The mean length of operation was 272 minutes and a R0 resection with a mean number of 16 nodes could be obtained in all the patients. No recurrence occurred during a follow-up of 28 months.
We conclude that this technique is a feasible, safe and valid adjunct to the double staple technique whenever intraabdominal application of the linear staple is difficult or unsafe.
Colorectal cancer, Laparoscopic anterior resection, Double, Low colorectal anastomosis, Stapling technique.
直肠全系膜切除直肠前切除术是治疗直肠癌的标准手术技术。腹腔镜低位前切除术（LALAR）是开放手术的替代方法，并且在各种随机对照试验中得到验证，具有安全性和肿瘤学有效性。即便如此，对于骨盆狭窄的肥胖患者，即使是最专业的外科医生，处理低位直肠肿瘤在技术上也具有挑战性。
我们提出一种改良的双吻合器技术，即经肛门外翻并吻合器切除直肠残端。
我们将上述技术应用于3例因患者/肿瘤特征导致远端切缘可疑的患者。平均手术时间为272分钟，所有患者均实现R0切除，平均清扫淋巴结16枚。随访28个月期间无复发。
我们得出结论，只要在腹腔内应用直线型吻合器困难或不安全时，该技术就是双吻合器技术可行、安全且有效的辅助方法。
结直肠癌；腹腔镜前切除术；双吻合器；低位结直肠吻合术；吻合器技术
