Triple-Staple Technique for Low Rectal Anastomoses Eliminates the Purse-String Suture and Facilitates Stapled Colorectal Anastomosis

Abstract

R T w 7 echniques used by surgical specialists often are slow in eaching broad use in general surgery because of genuine afety concerns, ease of use, and expense. Although the riple-staple technique has been reported for ileal -pouch anal anastomosis (IPAA), it is not widely used or IPAA or low colorectal anastomoses, even though it is oth safe and effective. Our technique involves use of a inear stapler to divide the proximal colon and avoid a urse-string suture, a reticulating stapler to divide the ower third rectum, and a circular stapler to create the nastomosis. The use of stapling devices has been widely acknowldged as a significant advance in digestive surgery, paricularly for low anterior resection. Although anastooses of the upper rectum can be hand sewn or stapled, any colorectal anastomoses of the lower third of recum, particularly in men, can best be performed using ircular stapler instruments. One of the major causes of echnical failure is, in our opinion, the use of pursetring suture on the proximal colon, the distal rectal tump, or both. Even when such a suture is placed by and, it does not ensure an intact anastomosis. Failure to nclude the entire circumference of the bowel wall, particlarly in large-caliber bowel, is frequently the cause of techical failure of purse-string sutures regardless of whether anual or automatic purse-string devices are used.