Improved techniques in E.E.A. Stapling for ultra low colorectal and colo-anal anastomosis

Techniques for routinely achieving intact ultralow end-to-end colorectal or colo-anal staple anastomoses have been examined in eight dogs and undertaken in six human subjects having segmental excision for low middle-third rectal carcinoma. A per-anum purse-string suturing technique into an ultra-short anorectal stump was used. Two methods were employed to appose the proximal divided rectum and the anorectal stump prior to stapling: (i) orthograde entry of the E.E.A. into the bowel (4 dogs and 3 humans); and (ii) high retrograde entry of the E.E.A. into the bowel (4 dogs and 3 humans). These techniques appear reliable methods to ensure complete envelopment of the cartridge and anvil by colon or rectal stump. Intact colo-anal anastomoses were achieved in seven dogs, and there was one anastomotic deficiency in the six patients. Anorectal incontinence in the patients has been a postoperative problem, but does improve with time. The techniques appear to offer greater reliability in construction of ultra-low colorectal or colo-anal end-to-end staple anastomosis after segmental excision of the rectum for low middle-third tumours than do more conventional stapling techniques.