End to End (Double stapled) Versus End to Side (Triple Stapled) Colorectal Anastomosis Following Anterior Resection for Rectal Cancer

Introduction Sphincter saving procedures for mid and low rectal cancers is made possible with the use of Double stapling (DS) technique. Most important complication is anastomotic leak, which depends on the technique of anastomosis apart from other factors. Our aim is to compare early outcomes between End-to-End (Double Stapled) and End-to-Side (Triple stapled) anastomosis following Anterior resection (AR). Methods All patients who underwent AR/LAR for rectal cancer during the period July 2014 to December 2016 were included. Following resection, patients were randomized to either End-to-End (EEA) or End-to-Side (ESA) anastomosis. Intra operative factors, and early postoperative outcomes were compared between two groups. P Value less than0.05 was considered significant. Results 73 patients were randomized.32 underwent EEA and 41 ESA. Demographic characteristics, nutritional status, BMI, preoperative chemoradiation, operative time, level of anastomosis and incidence of ileostomy were comparable. Doughnut integrity was maintained better in ESA group (87.8 % vs.65.6 %, p=0.0438). Air leak test was positive in 7 (21.87 %) in EEA group and 2 (4.87 %) in ESA group (p =0.0335). Postoperative leak was seen in 2 (6.25 %) in EEA group and 2 (4.87 %) in ESA group (p=1.00). All leak patients underwent reexploration and loop ileostomy. Conclusion End-to-side (triple stapled) anastomosis is easier to perform with better doughnut integrity with similar post operative leak rates.