Abstract A circular stapling apparatus was especially designed for use in low colorectal anastomoses. In shape and size it resembles a slightly oversized proctosigmoidoscope. After the tumor-bearing segment is resected in the standard manner, the instrument is introduced via the anus through the distal segment into the abdomen. The proximal and distal segments are apposed and mechanically anastomosed. A secure anastomosis is thus performed more quickly and more reliably than by standard suture methods. The method has been used successfully in 20 dogs, without evidence of leakage or stenosis. In 165 human operations for low rectal carcinoma performed in Russia from 1967 to 1972, the mortality was 2.4% and the leakage rate was 3.6%. No stenosis or late stricture occurred. References 1. Murphy JB: Cholecysto-intestinal, gastro-intestinal, entero-intestinal anastomosis and approximation without sutures . Med Rec 42:665-676, 1892. 2. Balfour DC: A method of anastomosis between sigmoid and rectum . Ann Surg 51:239-241, 1910.Crossref 3. Lockhart-Mummery JP: Diseases of the Rectum and Colon , ed 2. London, Baillière, Tindall and Cox, 1934. 4. Hallenbeck GA, Judd ED, David C: An instrument for colorectal anastomosis without sutures . Dis Colon Rectum 6:98-101, 1963.Crossref 5. Brummelkamp R: The rectoresector: A new instrument for resection of the rectum and colorectal anastomosis without sutures . Dis Colon Rectum 8:49-51, 1965.Crossref 6. Dixon CF: Anterior resection for carcinoma low in the sigmoid and rectosigmoid . Surgery 15:367-377, 1944. 7. Goligher JC, Graham NG, DeDombal FT: Anastomotic dehiscence after anterior resection of rectum and sigmoid . Br J Surg 57:109-118, 1970.Crossref 8. Morgenstern L, Yamakawa T, Ben-Shoshan M, et al: Anastomotic leakage after low colonic anastomosis: Clinical and experimental aspects . Am J Surg 123:104-109, 1972.Crossref 9. Baker JW: Low end to side rectosigmoidal anastomosis: Description of technic . Arch Surg 61:143-157, 1950.Crossref 10. Steichen FM: The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses . Surgery 64:948-953, 1968. 11. Ravitch MM, Ong TH, Gazzola L: New precise and rapid technique of intestinal resection and anastomosis with staples . Surg Gynecol Obstet 139:6-10, 1974.
Archives of Surgery – American Medical Association
Published: Sep 1, 1975