Salvaging a linear staple line defect in ultra-low anterior resection

The challenge of performing an ultra-low anterior resection has become technically possible with advances in surgical technique and equipment. The double stapled technique is frequently favored. Malfunction of equipment, however, can jeopardize an already difficult surgical procedure. Stapling across unhealthy tissue, such as irradiated rectal tissue, may also contribute. Two patients who underwent ultra-low anterior resections were noted to have a linear staple defect after linear stapling was performed. In these cases, an alternative to refashioning the anastomosis is to close the defect with handsewn sutures, incorporating the closed defect into the circular stapler. This was performed in both patients with good outcome. This technique can be used to salvage a defective staple line, as an alternative to refashioning the anastomosis.