Use of the End to End Anastomotic Stapler From Above for Difficult Pelvic Surgery for Distal Rectal Disease

Introduction Transabdominal utilization (TAU) of the end to end anastomotic (EEA) stapler in low anterior resection (LAR) for rectal cancer is an excellent alternative to the most widely performed techhnique. Methods We performed a retrospective analysis of a prospectively maintained database which obtained data on 104 patients with rectal disease who underwent EEA-assisted LAR with TAU. Records of all patients were used to evaluate demographics, complications, tumor location, margin status, postoperative complications, clinical sphincter function, adjuvant or neoadjuvant treatment, disease stage, and survival. Results Of the 104 patients, 48% were women with a mean age of 64 years (range 34-85 years). The average tumor location was 8 cm above the dentate line, and the mean tumor distance from the distal margin was 1.9 cm. All distal margins in cases for patients with rectal cancer were negative. Hospital length of stay averaged 8.7 days (6-15 days). There were no anastomotic complications (leaks, bleeding, or obstruction), and there were no leaks at the separate colotomy site. All patients have had normal postoperative sphincter function. Conclusion Transabdominal utilization of the EEA stapler in LAR for colorectal carcinoma is an alternative to the conventional approach and may be advantageous in avoidance of the lithotomy position with potential nerve injury, risk of deep venous thrombosis, and stapler-induced sphincter trauma.

Prospective, Multicenter Randomized Controlled Trial Comparing Two Hemorrhoidopexy Staplers: The HEMOSTASIS Study

The objective of this study was to compare two hemorrhoidopexy staplers (EEA versus PPH03). Stapled hemorrhoidopexy is a treatment option for patients with symptomatic internal hemorrhoids who have failed more conservative measures. However, staple line bleeding remains common. Recent improvements in stapler design have attempted to reduce intraoperative bleeding and the need for intervention. HEMOSTASIS is a prospective, multicenter, 1:1 randomized controlled trial. Twelve hospital centers in the United States enrolled participants between 18 and 85 years of age with symptomatic grades 2 to 3 internal hemorrhoids. The primary end point was intraoperative bleeding, defined as bleeding requiring intervention (e.g., placement of sutures, cauterization, or ligation to achieve hemostasis). Secondary end points included staple line location, postoperative pain, quality of life, operative time, length of hospital stay, adverse events, and complication rates. On the primary end point, the rates of intraoperative bleeding requiring intervention were 41.0% (32 of 78) with EEA and 70.4% (50 of 71) with PPH (P < 0.001). Treatment for active bleeding was required in 30.8% versus 57.7% (P < 0.001) in the EEA and PPH arms, respectively. There were no significant differences between groups in postoperative pain. Adverse events and perioperative complication rates were generally mild/moderate and were similar between groups: 74.1% (60 of 81) of patients in the EEA group reported at least one adverse event versus 80.9% (55 of 68) in the PPH group (P = 0.32). Intraoperative bleeding occurred less often after stapled hemorrhoidopexy with the EEA stapler compared with the PPH03 stapler. Intervention to achieve hemostasis was required less often with the EEA stapler.