# The Modified Triple Stapler Technique for Colorectal and Coloanal Anastomosis: A Retrospective Study of 132 Patients

## TL;DR

A modified surgical technique for colorectal anastomosis was found to be safe and effective in reducing complications in colorectal cancer and reversal surgeries.

## Contribution

The modified triple-staple technique eliminates the need for a purse-string suture, potentially improving surgical efficiency and ergonomics.

## Key findings

- No major intraoperative complications were observed in 132 patients.
- Anastomotic leakage occurred in 8% of patients, with strictures in 2%.
- Postoperative ileus occurred in 7% of cases, and abdominal collections in 2%.

## Abstract

Aim

The objective of this study was to evaluate the safety and efficacy of the modified triple-staple technique in anterior resection for colorectal cancer patients and Hartmann’s reversal surgeries done by a single surgeon. We hypothesized that by using this technique and omitting the purse-string suture, we could reduce operative time and enhance ergonomic benefits.

The study was conducted in accordance with local clinical governance unit protocols and adhered to the Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) guidelines.

Methods

This retrospective cohort study aimed to evaluate patients who underwent colorectal anastomosis as part of either Hartmann’s reversal or colorectal cancer surgeries over a 15-year period, from January 2010 to January 2025.

A total of 132 patients who underwent anterior resection for colorectal cancer or Hartmann’s reversal were included. A modified triple staple technique for end-to-end colorectal and coloanal anastomosis was performed without the use of a purse-string suture on both the proximal and distal segments. The safety and efficacy of this technique were assessed by monitoring complication rates, including intraoperative complications, anastomotic leaks, and strictures.

Results

There were no major intraoperative complications reported. Anastomotic leakage occurred in 11 patients (8%), while strictures developed in 2 patients (2%). Postoperative abdominal collections were observed in three patients (2%), and postoperative ileus occurred in nine patients (7%).

Conclusion

The modified triple stapler technique for end-to-end anastomosis offers a safe and effective alternative to the conventional purse-string double stapler technique.