Kim Nam Seok, Kim Ji Hoon, Lee Yoon Suk, Lee In Kyu, Kang Won Kyung
Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Ann Coloproctol. 2024 Dec;40(6):573-579. doi: 10.3393/ac.2022.00409.0058. Epub 2024 Nov 22.
This study aimed to demonstrate the safety of new double-stapling technique (nDST), without a crossing line and dog ears, by comparing with conventional DST (cDST) in laparoscopic low anterior resection (LAR).
We retrospectively reviewed 98 consecutive patients who underwent laparoscopic LAR for rectal cancer from January 2018 to December 2020. The inclusion criterion was an anastomosis level below the peritoneal reflection and 4 cm above the anal verge. In the nDST group, the staple line of the linear cutter was sutured using barbed sutures to shorten the staple line before firing the circular stapler. Therefore, there were no crossing lines after firing the circular stapler. A 2:1 propensity score matching was performed between the cDST and nDST groups.
After propensity score matching, 39 patients were in the cDST group and 20 were in the nDST group. There were no significant differences in patient demographics between the 2 groups. There was no difference in the total operation time between the cDST and nDST groups (124.0±26.2 minutes vs. 125.2±20.3 minutes, P=0.853). Morbidity rates were similar between the 2 groups (9 cases [23.1%] vs. 5 cases [25.0%], P=0.855). There was no significant difference in leakage rate (4 cases [10.3%] vs. 1 case [5.0%], P=0.847) and anastomotic bleeding rate (1 case [2.6%] vs. 3 cases [15.0%], P=0.211).
The nDST to eliminate the crossing line and dog ears in laparoscopic LAR is technically feasible and safe. However, more attention should be paid to anastomotic bleeding in such cases.
本研究旨在通过在腹腔镜低位前切除术（LAR）中与传统双吻合技术（cDST）进行比较，证明新型无交叉线和狗耳的双吻合技术（nDST）的安全性。
我们回顾性分析了2018年1月至2020年12月期间连续98例行腹腔镜LAR治疗直肠癌的患者。纳入标准为吻合口位于腹膜反折以下且距肛缘4 cm以上。在nDST组中，在发射圆形吻合器之前，使用倒刺缝线缝合线性切割器的钉合线以缩短钉合线。因此，发射圆形吻合器后没有交叉线。在cDST组和nDST组之间进行了2:1的倾向评分匹配。
倾向评分匹配后，cDST组有39例患者，nDST组有20例患者。两组患者的人口统计学特征无显著差异。cDST组和nDST组的总手术时间无差异（124.0±26.2分钟 vs. 125.2±20.3分钟，P = 0.853）。两组的发病率相似（9例[23.1%] vs. 5例[25.0%]，P = 0.855）。渗漏率（4例[10.3%] vs. 1例[5.0%]，P = 0.847）和吻合口出血率（1例[2.6%] vs. 3例[15.0%]，P = 0.211）无显著差异。
在腹腔镜LAR中消除交叉线和狗耳的nDST在技术上是可行且安全的。然而，在这种情况下应更加关注吻合口出血。
