title: Ligation of the rectum with an extracorporeal sliding knot facilitating laparoscopic cross-stapling: a procedure revisited.
abstract: BACKGROUND
  Multiple stapler firings during distal rectal division were associated with unduly long stapler line and anastomotic leakage after laparoscopic rectal resection. A simple and relatively easy technique to perform a safe transection of rectum is presented.
  
  
  METHODS
  The extracorporeal ligation of the rectum just proximal to the cut end of the rectum before applying the linear stapling stapler facilitates the procedure and requires only a few firings of the stapler during the laparoscopic rectal resections.
  
  
  RESULTS
  Ten patients with a median age of 72 years underwent rectal transection with this technique. The procedure was performed with a single 60-mm cartridge in 3 patients, and two firings of the Endo GIA™ (Covidien LLC, Mansfield, MA) with a 45-mm cartridge were necessary for cross-stapling at the level of the pelvic floor in the remaining patients. There were no intraoperative complications. Postoperative complications were seen in 2 patients.
  
  
  CONCLUSIONS
  This simple technique theoretically seems safer than the conventional approach and should be considered as an additional option for rectal transection.
authors.affiliation: Department of Surgical Gastroenterology, Hvidovre University Hospital, University of Copenhagen , Copenhagen, Denmark .
authors.forename: Orhan
authors.initials: O
authors.lastname: Bulut
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome