title: Technique for a stapled anastomosis following transanal total mesorectal excision for rectal cancer.
abstract: OBJECTIVE
  Transanal total mesorectal excision (taTME) is an emerging and exciting new technique in rectal cancer surgery. As with all novel techniques, new challenges arise, requiring small modifications of the technique. Here we present a simple technique that we have devised to facilitate a stapled anastomosis using standard circular staplers following a taTME.
  
  
  METHODS
  We describe the technique in a stepwise fashion with picture - and video illustration. Our experience with this anastomosis in a small cohort of patients is reported.
  
  
  RESULTS
  No anastomotic leaks occurred in 12 consecutive patients using this technique following taTME. In one patient a small defect was noticed on direct visualisation of the anastomosis intra-operative, and was closed transanally. So far 8/12 patient had their protective ileostomy reversed with satisfactory function.
  
  
  CONCLUSIONS
  We believe that this technique for a transanal, stapled anastomosis after a transanal TME procedure is safe and reproducible. Objective assessment of longterm functional outcome is required and outcomes need to be compared to other stapled techniques and handsewn anastomoses.
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: E
authors.initials: E
authors.lastname: Bracey
authors.affiliation: Virga Jesse Hospital, Hasselt, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Knol
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: N
authors.initials: N
authors.lastname: Buchs
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: O
authors.initials: O
authors.lastname: Jones
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Guy
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: N
authors.initials: N
authors.lastname: Mortensen
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hompes
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061214:Patient Safety; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012494:Sampling Studies; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome
keywords: Total mesorectal excision; rectal cancer; transanal TME