Intra-operative double-stapled colorectal or coloanal anastomotic complications of laparoscopic low anterior resection for rectal cancer: double-stapled anastomotic complication could result in persistent anastomotic leakage

Background: Laparoscopic surgery for rectal cancer is technically demanding and can be hindered by unexpected intra-operative complications. Among the various intra-operative complications, double-stapled anastomotic complications are more serious and complicated to manage. The purpose of this study is to analyze the impact of intra-operative double-stapled colorectal or coloanal anastomotic complications on short-term surgical outcomes and persistent leak, and risk factors of intra-operative double-stapled anastomotic complication.

Methods: Consecutive 363 cases of laparoscopic low anterior resection from August 2004 to November 2012 were analyzed in this study. We retrospectively reviewed intra-operative double-stapled anastomotic complications and compared patient characteristics, surgical data, post-operative clinical data, and pathological data between groups with and without intra-operative double-stapled anastomotic complications. And we analyzed risk factors for double-stapled anastomotic complication.

Results: There were 20 intra-operative double-stapled anastomotic complications among the patients (5.5 %). Operation time was longer (304.8 ± 122.0 vs. 197.1 ± 87.5 min, p = 0.001) and more diversion ileostomy were made (75 vs. 34.7 %, p < 0.001) in the group with double-stapled anastomotic complications. There were no differences in terms of surgical morbidity, conversion rate, anastomotic leakage, and hospital stay. However, there was more persistent anastomotic leakage (15 vs. 0.9 %, p = 0.003) in the group with double-stapled anastomotic complications. In univariate analysis, risk factors for double-stapled anastomotic complications were male, T4 stage lesion, and three or more stapler firings.

Conclusions: The double-stapled anastomotic complications during laparoscopic low anterior resection increased operation time and rate of diversion ileostomy. Although these factors did not adversely affect short-term surgical outcome including post-operative morbidity and anastomotic leakage, double-stapled anastomotic complications could increase persistent anastomotic leakage rate.