Single-stapled left-sided colorectal anastomoses – a pilot study

Abstract Introduction Anastomotic surgery is often performed for left-sided colorectal cancer. Colorectal anastomoses may leak, with subsequent morbidity and sometimes mortality. The predominating double-stapled technique results in intersecting staple lines, which are theoretical weak points. This IDEAL 2a study focuses on iterative improvement of a single-stapled technique without the above shortcomings, aiming towards a multicentre trial. Method A single-stapled technique was introduced during 2023-2024 on patients operated with left hemicolectomy or high anterior resection for cancer. This involved removal of the rectal staple line followed by a purse-string suture around the spike of a circular stapler, after which an end-to-end anastomosis was formed. Anastomotic leaks were registered within 90 days of surgery. A chart-reviewed cohort from 2023–2024 was included, while a prospective cohort study for 2025–2026 is currently recruiting. Result Four sigmoid and two rectal cancer patients were identified retrospectively, while two sigmoid and five rectal cancer patients in the prospective cohort had a single-stapled anastomosis. The lowest anastomosis thus far was constructed at 6 cm from the anal verge. One rectal cancer patient suffered a leak, where a thin doughnut was observed. There has been one instance where a decision was made not to perform a single-stapled anastomosis due to perceived difficulty; this male patient underwent a robotassisted operation with rectal transection at 6 cm, necessitating a division of the rectum with two 60 mm stapler firings. Discussion Our proposal of forming a single-stapled colorectal anastomosis is in the final stages, with encouraging findings so far. Inclusion is on-going and more centres are welcome.