Quadruple purse-string suture for single stapling technique following transanal total mesorectal excision for rectal cancer

Abstract Purpose: Transanal total mesorectal excision (TaTME) for low anterior resection requires a secure anastomotic technique to avoid an anastomotic leak. This study aimed to evaluate the clinical outcomes of a novel technique of quadruple purse-string suture (PSS) for single stapling technique (SST) following TaTME. Methods: Consecutive patients who underwent TaTME with SST for rectal cancer between November 2014 and October 2020 were enrolled. Clinical outcomes of quadruple or double PSS for SST following TaTME were evaluated. The complete rates of the resection rings based on the status of the resection ring of the colonic and rectal stumps were also evaluated. Results: In total, 47 patients were included in the study: 27 and 20 in the quadruple and double PSS groups, respectively. Intraoperative adverse events occurred in one patient. The rates of postoperative complications in the quadruple and double PSS groups were 22.2% and 30.0%, respectively. The rates of anastomotic leaks in the quadruple and double PSS groups were 7.4% and 15.0%, respectively. The length of hospital stay in the quadruple and double PSS groups was 13 and 14 days, respectively. The resection ring for the rectal stump was complete in 85.2% of quadruple PSS cases and 70.0% of double PSS cases. The resection rings for both stumps were complete in 81.5% and 50.0% of patients with quadruple and double PSS, respectively (p=0.03). Conclusion: Quadruple PSS for SST following TaTME is feasible and seems to be a safe alternative to conventional double PSS in selected patients with rectal cancer.