Autosuture of low colorectal anastomosis

The safety of low colorectal anastomosis constructed with autosuture technique (U.S. EEA-stapling device, USSC) and the functional results were assessed in consecutive series of patients operated upon for rectal carcinoma. The operative procedure was greatly facilitated and certainly, many of the patients would otherwise have been subjected to abdominoperineal resection with permanent colostomy. Clinical leaks were observed in 4 of the 25 patients (16%) and another 4 patients were shown to have subclinical leaks, as demonstrated by endoscopy and/or X-ray. The total incidence of leaks was therefore 32% (8/25). Even when constructed with the autosuture technique a low anastomosis should probably be protected by a proximal enterostomy. There was a general tendency to anastomic narrowing during the initial period but in most patients stenosis disappeared with time after closure of the enterostomy. Frequent endoscopic examinations and dilatation of the anastomosis during the early postoperative period may be advantageous. The immediate functional results were unsatisfactory with increased frequency and varying grades of incontinence. Although these disturbances improved with time the results at six months after surgery were still not satisfactory and for confidence many patients wore a pad.