Annals of Coloproctology

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Colorectal cancer

Linear versus circular stapler for colorectal anastomosis in laparoscopic sigmoidectomy: a retrospective comparative study: Hiep Van Pham, Thang Manh Tran, Phuong Nguyen Nhu Pham; Ann Coloproctol. 2026;42(4):468-477. Published online August 26, 2026; DOI: https://doi.org/10.3393/ac.2025.01242.0177

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Graphical Abstract Abstract PDF: Purpose
The choice between linear side-to-side and circular end-to-end staplers for colorectal anastomosis after laparoscopic sigmoidectomy remains a topic of debate. This study compared intraoperative efficiency, postoperative recovery, complications, and quality of life (QoL) between the 2 techniques.
Methods
This retrospective cohort study included 83 patients who underwent elective laparoscopic sigmoidectomy for sigmoid cancer at a single center between January 2023 and August 2024. Patients were grouped according to the stapling technique used for anastomosis (linear stapler, n=23; circular stapler, n=60). Intraoperative characteristics, including operative time and stapler use; postoperative outcomes, including length of hospital stay and complications; and longitudinal QoL, assessed using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire–Colorectal Cancer (QLQ-CR29) questionnaire at 1, 3, 6, 9, and 12 months, were analyzed.
Results
Baseline characteristics were comparable between groups. Operative time did not differ significantly between the linear and circular stapler groups (90.73±14.02 minutes vs. 94.63±13.65 minutes, P=0.25). The linear stapler group required more staplers overall (3.04±0.82 vs. 1.53±0.72, P<0.001) but had a shorter hospital stay (10.09±1.83 days vs. 11.70±3.62 days, P=0.04). Oncologic outcomes and complication rates were low and comparable (anastomotic leakage: 4.3% vs. 0%, P=0.277). At 12 months, QoL scores did not differ significantly between groups, although descriptive trends suggested faster recovery of bowel function and abdominal pain in the linear stapler group during the first 6 months.
Conclusion
In this single-center retrospective series, both linear side-to-side and circular end-to-end stapling techniques appeared safe, feasible, and clinically acceptable. Circular stapling required fewer stapling devices intraoperatively, whereas linear stapling was associated with modestly shorter hospitalization and descriptively faster early functional recovery. These findings are hypothesis-generating and warrant prospective validation in larger, balanced cohorts to guide patient- and technique-specific surgical decision-making.

Anorectal benign disease

Proctitis distal to colorectal anastomosis: a retrospective cohort study of an underreported complication after sigmoidectomy: Ajmal Khan, Maziar Nikberg, Kenneth Smedh, Abbas Chabok; Ann Coloproctol. 2024;40(5):498-505. Published online October 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00675.0096

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Abstract PDF: Purpose
Proctitis distal to colorectal anastomosis is rare and infrequently reported. We evaluated the incidence, symptoms, treatment, and potential risk factors associated with this condition.
Methods
We conducted a retrospective population-based cohort study in Västmanland County, Sweden. This investigation included all patients who underwent sigmoidectomy with colorectal anastomosis between 2008 and 2020. We excluded patients without an anastomosis and those with inflammatory bowel disease.
Results
Of the 546 patients identified, 233 fulfilled the inclusion criteria, of whom 26 (11.2%) developed proctitis distal to colorectal anastomosis. The most frequent symptoms included urgency (n=16, 61.5%), increased stool frequency (n=12, 46.2%), and anorectal pain (n=12, 46.2%). Endoscopic balloon dilation was performed in 20 cases (76.9%), with 10 requiring only a single therapeutic procedure. The median number of dilations was 3 (range, 1–8). Multivariable analysis revealed that surgery due to malignancy and emergency surgery were associated with elevated risk of proctitis. A subgroup analysis of patients who underwent surgery due to malignancy indicated that smoking (odds ratio, 3.9; 95% confidence interval, 1.1–14.0) and emergency surgery (odds ratio, 6.5; 95% confidence interval, 1.1–37.1) were also associated with increased proctitis risk.
Conclusion
Proctitis distal to colorectal anastomosis is not uncommon following sigmoidectomy. Patients undergoing emergency surgery or surgery due to malignancy and who had a history of smoking displayed an increased risk of developing proctitis. Due to the paucity of symptoms observed, particularly in patients with a diverting stoma, routine endoscopic rectal examination should be performed during follow-up after sigmoidectomy.

Perineal Rectosigmoidectomy with Levatoroplasty for Rectal Prolapse Early functional outcome.: Yoon, Seo Gue , Lee, Jong Ho , Yoon, Jong Seob , Kim, Kuhn Uk , Kim, Hyun Shig , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(5):220-226.

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Abstract PDF: PURPOSE
This study was designed to analyze the short-term clinical and functional outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse.
METHODS
The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner's constipation score (0-30), Wexner's incontinence score (0-20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3-6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7).
RESULTS
During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated.
CONCLUSIONS
Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea-predominant irritable bowel syndrome.

Case Report

Complete Rectal Prolapse Combined with Rectal Cancer: A Case Report.: Lee, Tae Soon , Bae, Ok Suk , Park, Sung Dae; J Korean Soc Coloproctol. 2005;21(3):178-180.

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Abstract PDF: Colorectal cancer and rectal prolapse occur more frequently in elderly patients. Although the relationship between complete rectal prolapse and colorectal cancer has not yet been clarified, when both diseases develop simultaneously in a patient, it may be due to just coincidence or to a promotion of prolapse due to accelerated constipation caused by cancer. Thus, patients with a sudden onset of rectal prolapse should be screened for colorectal cancer. We report a case of complete rectal prolapse combined with early rectal cancer in a 75 year-old woman who was successfully treated with a perineal rectosigmoidectomy.

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