Natural orifice specimen extraction with single-stapling anastomosis for distal colon resection: Feasibility and outcomes

Background: The double-stapling technique (DST) and triple-stapling technique used in laparoscopic anterior resection are considered risk factors of leakage or anastomotic leakage. A high anastomotic leakage rate could be avoided by the single-stapling technique (SST). Purposes: This study analyzed the feasibility, as well as the operative and immediate postoperative outcomes of natural orifice specimen extraction (NOSE) with single-stapled anastomosis. Materials and Methods: We retrospectively analyzed the data of 82 patients from China Medical University Hospital who underwent elective surgery from January 2012 to April 2015 for benign or malignant lesions that were between 10 and 40 cm from the anal verge, ≤5 cm in diameter on radiological examination, and in stage T1-T3/Nx/M0. All patients were monitored according to the enhanced recovery after surgery protocol. Results: NOSE with SST was feasible and showed intraoperative complication and morbidity rates of 2% and 7.3%, respectively. No patients needed conversion to open surgery. The rate of conversion to NOSE with DST was 6.1%. Moreover, the anastomotic leakage rate was 2.4%. Total hospital stay required was 4.8 ± 3.4 days. The first postoperative bowel movement observed was at 1.2 ± 0.5 days. Conclusions: Although SST is technically challenging, NOSE with SST is as feasible and as NOSE with DST