EAES Academy

Anastomotic leakage (AL) in rectal resection is a serious complication. Patient factors such as age and medical history, as well as surgical factors such as tension, blood flow, and mechanical strength of the reconstructed colon, contribute to AL. We focused on mechanical strength. After the mesentery was processed and the rectum was straightened to the state just before resectioning, intraoperative EUS was performed to measure the surgical wall thickness (SWaT) at three locations: anterior, posterior, and lateral walls. In the result, the thickness of the rectal wall was 2.3 mm in the median and 2.4 mm in the mean. We also used the real time feedback (RTF) system of the Signia stapling system, which can measure the pressure resistance of the colon wall in 4 steps (1-4), to measure the pressure resistance at the time of intussusception. In the result, rectal resistance to pressure was RTF:1/2/3 = 61%/31%/8%. Furthermore, there was a correlation between SWaT and RTF, but no correlation between SWaT and gender or BMI.
The selection of the height of the circular stapler at the time of rectal anastomosis with the circular stapler has been based on the surgeon's subjective judgment, such as gender, BMI, and the presence or absence of preoperative bowel obstruction, but our study suggests that this alone is not sufficient for appropriate selection. Our study suggests that intraoperative SWaT and RTF measurements can be used to make appropriate and well-founded choices.