Complications after double and single stapling in rectal surgery.

Stapled anterior resections were carried out in 131 patients between October 1980 and July 1990. Double stapling was used in 87 cases and single stapling in 44. Clinical leaks occurred in 20 patients (15%) and subclinical leaks in 10 (8%) giving a total leak rate of 30/131 (23%). This proportion was similar after double (19/87, 22%) and single (11/44, 25%) stapling. Three fistulas to adjacent organs developed (two after double and one after single stapling). Stenoses occurred in 27 patients (21%), 15/87 (17%) after double, and 12/44 (27%) after single stapling. A permanent stoma was the outcome of an anastomotic complication in 9/87 (10%) patients after double and in 4/44 (9%) after single stapling. The main risk factors were: the number of blood transfusions was related to the risk of dehiscence (p = 0.01), a small cartridge size increased the risk of stenosis (p = 0.002) and previous radiotherapy increased the probability of a permanent stoma (p = 0.0005).