The effect of staple height and rectal-wall thickness on anastomotic leakage after laparoscopic low anterior resection

Background: The aim of this study was to evaluate the effect of staple height and rectal wall thickness on the development of an anastomotic leak after laparoscopic low anterior resection performed with the double stapling technique.Methods: One hundred ninety-nine patients treated from 2013 to 2021 were enrolled. Patients were divided into two groups: those who developed an anastomotic leak (AL (+)) and those who did not (AL (-)). Clinicopathological factors were compared between the groups.Results: Anastomotic leaks were observed in 8/199 patients (4%). A 1.5 mm linear stapler was used for 35/199 patients (17%), 1.8 mm for 89 (45%), and 2 mm for 75 (38%). In the AL (+) group (n = 8), lower staple height (1.5 mm or 1.8 mm) was used more frequently than in the AL (-) group (n = 191). Rectal wall thickness and the rectal wall thickness to staple height ratio was significantly (p < .05) greater in the AL (+) group. However, rectal wall thickness was significantly (p < .05) greater in patients who received neoadjuvant treatment and those with advanced T stage (T3,4) lesions.Conclusion: Linear stapler staple height and rectal wall thickness are significantly associated with the development of an anastomotic leak after laparoscopic low anterior resection. Larger staples should be selected in patients with a thicker rectal wall due to neoadjuvant treatment or adjacent advanced rectal tumors.(c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Automated summary

The study aimed to assess the impact of staple height and rectal wall thickness on the development of an anastomotic leak following laparoscopic low anterior resection. A total of 199 patients treated between 2013 and 2021 were included and divided into two groups based on the presence of an anastomotic leak. Clinicopathological factors were compared between the groups. The results showed that the rate of anastomotic leaks was 4%. Lower staple height (1.5 mm or 1.8 mm) was used more frequently in the leak group, and rectal wall thickness and the rectal wall thickness to staple height ratio were significantly associated with anastomotic leaks. However, rectal wall thickness was significantly increased in patients who received neoadjuvant treatment and those with advanced T stage tumors. In conclusion, linear stapler staple height and rectal wall thickness are closely associated with the development of an anastomotic leak after laparoscopic low anterior resection. Larger staples should be selected for patients with thicker rectal walls.