Modified surgical techniques for the superlow anterior resection.
BACKGROUND/AIMS: Superlow anterior resection remains a technical challenge because it involves bowel resection and anastomosis in deep, limited pelvic space. Some modifications of the standard double stapling technique are thus needed to facilitate the procedure, making it safer, easier and more reliable. METHODOLOGY: A Roticulator is applied to make the first staple if the pelvic space is wide enough. A puncture hole is made manually in the closed rectal stump with the anvil tip under direct vision. If the pelvis is too narrow to apply a Roticulator, a purse-string suture is first placed before bowel resection, and is then tied securely around the anvil shaft to close the rectal stump. In either condition, the anvil and the attached sigmoid colon are pushed manually to evert the closed rectal stump. The stapled end-to-end anastomosis is then made outside the anus. RESULTS: From July 1994 to June 1996, 42 superlow anterior resections were performed using the modified techniques. There were only 2 cases of anastomotic leakage. The function results were acceptable. CONCLUSIONS: The modified techniques are safe, effective and easy to perform. Their major advantages are that the stapled anastomosis is made under direct vision and without the hindrance of pelvic tissue.