IMPROVED TECHNIQUES IN E.E.A. STAPLING FOR ULTRA LOW COLORECTAL AND COLO‐ANAL ANASTOMOSIS

Abstract

Techniques for routinely achieving intact ultra-low end-to-end colorectal or colo-anal staple anastomoses were examined in 8 dogs and undertaken in 6 human subjects having segmental excision for low middle-third rectal carcinoma. A per-anum purse-string suturing technique into an ultra-short anorectal stump was used. Two methods were employed to appose the proximal divided rectum and the anorectal stump prior to stapling: orthograde entry of the E.E.A. (end-to-end anastomosis) into the bowel (4 dogs and 3 humans) and high retrograde entry of the E.E.A. into the bowel (4 dogs and 3 humans). These techniques appear reliable methods to ensure complete envelopment of the cartridge and anvil by colon or rectal stump. Intact colo-anal anastomoses were achieved in 7 dogs and there was 1 anastomotic deficiency in the 6 patients. Anorectal incontinence in the patients was a postoperative problem, but does improve with time. The techniques apparently offer greater reliability in construction of ultra-low colorectal or colo-anal end-to-end staple anastomosis after segmental excision of the rectum for low middle-third tumors than do more conventional stapling techniques.