Clinical Efficacy Observation Of The Modified Procedure Of Laparoscopic Double-stapling Technique For Mid-low Rectal Cancer

Objective:Observe clinical efficacy and explore clinical value of the modified procedure of laparoscopic double-stapling technique for mid-low rectal cancer.Methods:Clinical data of 125 patients with mid-low rectal cancer under performing laparoscopic anterior resection in the Department of General Surgery of the First Affiliated Hospital of Soochow University from February 2011 to February 2015 was analyzed retrospectively. According to the different ways of double-stapling technique in surgery, we divide data into the modified anastomosis group which has 51 cases and the conventional anastomosis group which has 74 cases. When we handle the "First Match" of double-stapling technique anastomosis in surgery, conventional horizontal direction of rectum distal cutting and closing is modified to the vertical direction. When we handle the "Second Match", conventional "End-End" anastomosis between the intestines is modified to "End-Corner" anastomosis. Thereby upper corner of the closed line in the distal end of rectum was removed. The lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method and only one T-shaped interchanges ("Dangerous Triangle") of stapled sutures formed after anastomosis were strengthened with absorbable suture. The two "Dog Ears" and the two "Dangerous Triangles" were kept without any treatment under performing double-stapling technique in surgery. The clinical data from multiple aspects of the two groups of patients was analyzed retrospectively. Such as intraoperative indicators (Blood loss, Operation time), Pathological specimens indicators (Tumor size, Pathological type, The number of lymph node dissection, Lymph node metastasis, Dukes stage), Postoperative indicators (Anal exhaust time, Consumption of liquidtime, Pull the catheter days, Drainage tube indwelling Days, Length of hospital stay after surgery), Postoperative complications (Anastomotic leak, Anastomotic bleeding, Intestinal obstruction, Reoperation stoma, Tenesmus, Various types of infections), Postoperative follow-up case (Change in defecation habits, Local tumor recurrence rate, Tumor metastasis rate, Survival rate). To explore clinical efficacy of the modified procedure of laparoscopic double-stapling technique for mid-low rectal cancer.Results:Data of two groups was compared, such as general information, information on pathological specimens, blood loss, anal exhaust time, consumption of liquid time, pull the catheter days, anastomotic bleeding, intestinal obstruction, reoperation stoma, various types of infections and postoperative follow-up cases, and difference in those areas was not statistically significant (P>0.05).Operation time in the modified anastomosis group is longer than that of the conventional anastomosis group (168.90±23.41 vs 150.34±42.13, P<0.05), but it has shorter drainage tube indwelling days (7.94±2.94 vs 10.76±11.59, P<0.05) and length of hospital stay after surgery (9.98±3.64 vs 13.32±13.67, P<0.05). The incidence of anastomotic leakage (2.0% vs 18.9%, P<0.05) and tenesmus (3.9% vs 17.6%, P<0.05) in the modified anastomosis group is less than that of the conventional anastomosis group.Conclusion:Conventional horizontal direction of rectum distal cutting and closing is modified to the vertical direction and conventional "End-End" anastomosis between the intestines is modified to "End-Corner" anastomosis in the modified anastomosis group. The first measure facilitates intraoperative observation and removal of two "dog ears" and a "dangerous triangle". The second measure contributes to remove two "dog ears" and a "dangerous triangle" and facilitates to strengthen suture another "dangerous triangle" and strengthens structurally weak point of original anastomotic stoma and prone point of postoperative complications. The modified procedure of laparoscopic double-stapling technique for mid-low rectal canceris effective and feasible. These measures play a positive role in reducing the incidence of post-surgical complications such as anastomotic leakage and "low anterior resection syndrome".