The low stapled anastomosis

The complications of 100 stapled anastomoses onto the rectum or anus are reviewed. Anastomotic leakage in very low cases is the major problem; no leak occurred if the anastomosis was performed above 7 cm, but 3 leaks in 17 patients occurred if the anastomosis was performed between 5.5 and 7 cm, and 10 leaks occurred in 52 patients if the anastomoses was less than 5 cm from the anal margin. A covering colostomy is essential for these lower anastomoses, and for those not covered by a colostomy, an immediate colostomy with a distal loop washout is performed, if a leak develops. Attention to technique is mandatory, with a good blood supply, absence of tension and the elimination of the pelvic cavity being of great importance.