title: The occlusive tourniquet: a simple method for rectal stump washout during open and laparoscopic surgery.
abstract: Rectal stump washout with cytolytic agents is recommended and usually performed during anterior rectal or rectosigmoid resection. The use of a linear stapler instrument during ultralow anterior resection makes the placement of pelvic clamps difficult for rectal stump washout prior to resection. The objective of this work is to demonstrate the use of a simple procedure, the occlusive tourniquet for rectal stump washout. Occlusive tourniquet applied to open technique: after complete dissection of the rectum and sigmoid colon according to the usual technique, a simple piece of tubing from an intravenous line is passed behind and around the rectum/sigmoid colon at some point distal to the tumor to form an occlusive tourniquet. Occlusive tourniquet applied to laparoscopic technique: similar to the open technique, tubing is passed through the left iliac fossa trocar and passed behind the sigmoid mesocolon. This simple procedure allows easy exposure and dissection of the mesorectum, without traumatizing the rectum/sigmoid colon or the tumor and lavage can be performed without the need for clamps or other instruments which may traumatize the rectum and provoke anastomotic failure. In conclusion, the occlusive tourniquet is a simple method for rectal stump washout so this step can be done.
authors.affiliation: Coloproctology Unit, Department of Surgery, Hospital Clinico, University of Valencia, Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: García-Granero
authors.forename: Blas
authors.initials: B
authors.lastname: Flor-Lorente
authors.forename: Stephanie
authors.initials: S
authors.lastname: García-Botello
authors.forename: Elena
authors.initials: E
authors.lastname: Muñoz
authors.forename: Francisco
authors.initials: F
authors.lastname: Blanco
authors.forename: Salvador
authors.initials: S
authors.lastname: Lledó
mesh_terms: D006801:Humans; D010535:Laparoscopy; D012004:Rectal Neoplasms / Q000601:surgery*; D014111:Tourniquets