Results of the double stapling procedure in pelvic surgery

The double stapling technique for rectal reconstruction after resection involves closing the lower rectal segment with a linear stapler and performing the anastomosis using a circular stapler across the linear staple row. The purpose of this report is to review the results of double stapling, present our experience, and draw conclusions from the material available. We have utilized the double stapling technique in 80 patients for primary anastomoses and in 11 patients for secondary anastomoses following Hartmann procedures. Twenty‐one anastomoses were at or near the dentate line. Fifty‐six patients had rectal carcinoma, 29 patients had diverticulitis, 3 patients had carcinoma of the ovary, and 1 patient each had traumatic rectal perforation, volvulus, or rectal prolapse. Complications in the total 91 patients included 3 anastomotic leaks (3.3%), 1 postoperative hemoperitoneum (1.1%), and 3 strictures (3.3%). No anastomosis was protected by diverting colostomy. There were no operative deaths. Of 43 patients with cancer available for follow‐up, 4 patients have developed local recurrence. The technique has been modified for ileoanal anastomosis during abdominal restorative proctocolectomy for ulcerative colitis and familial polyposis and early results are favorable. The double stapling technique provides a safe method for rectal reconstruction at or near the dentate line and offers the following advantages over other stapler techniques: (1) It eliminates the frustrating distal pursestring; (2) The rectal segment is not opened, minimizing contamination; and (3) It avoids gathering the sometimes generous circumference of the rectum on a pursestring thus allowing a more precise distal donut. Résumé La technique de double agrafage pour anastomose colorectale consiste en la fermeture du moignon rectal par une pince à agrafage linéaire suivie ensuite d'une anastomose par une pince à agrafage circulaire à travers la ligne d'agraphes du moignon. Le but de cet article est, d'après notre expérience avec cette technique, de revoir les résultats à distance et de tirer des conclusions sur le matériel autuellement disponible. Nous avons utilisé technique dans 80 cas d'anastomose primaire et dans 11 anastomoses secondaires lors du rétablissement de continuité après opération de Hartmann. Vingt et une de ces anastomoses étaient faites au niveau de la ligne pectinée. Cinquante‐six patients avaient un cancer rectal, 29 avaient eu une diverticulose, 3, un cancer de l'ovaire alo