title: Improved techniques in E.E.A. Stapling for ultra low colorectal and colo-anal anastomosis.
abstract: Techniques for routinely achieving intact ultralow end-to-end colorectal or colo-anal staple anastomoses have been examined in eight dogs and undertaken in six 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: (i) orthograde entry of the E.E.A. into the bowel (4 dogs and 3 humans); and (ii) 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 seven dogs, and there was one anastomotic deficiency in the six patients. Anorectal incontinence in the patients has been a postoperative problem, but does improve with time. The techniques appear to 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 tumours than do more conventional stapling techniques.
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000818:Animals; D003106:Colon / Q000601:surgery*; D004285:Dogs; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D013528:Surgical Staplers; D013536:Suture Techniques