Anastomosis technique, gastrointestinal, with circular stapler - general and visceral surgery

The technique is illustrated with descendorectostomy serving as an example (see also open rectal resection). The rectum is transected with a linear stapler.

Free the section of intestine to be anastomosed from the attached tissue over a distance of 5-10 mm.

First, clean and disinfect the proximal stump of the large bowel with a swab (e.g., soaked in povidone-iodine) (not illustrated). Then preplace an over-and-over purse-string suture of strong monofilament material with stitches every 4 mm Finally, insert the anvil and tie the purse string suture on the anvil shaft.

Note: The purse-string suture may also be fashioned with a purse-string clamp and a double-ended suture with straight needles.

Insert the stapler transanally and pierce the staple line with the trocar of the staple housing.

Note: In the video, the trocar has already been removed.

Slide the anvil shaft over the trocar until the anvil snaps into fully seated position.

Partially close the device while checking visually for any interposed adjacent tissue. Then fully close the device by turning the screw on the handle thereby approximating the stumps of the bowel. The window in the device will turn green as soon as the stumps are in full contact. Then fire the device by compressing the handles.

Slightly open and withdraw the device while carefully rotating it clockwise and counterclockwise. Checking the punched-out tissue donuts: The purse-string suture and both punched out donuts must be intact.

Once the anastomosis has been fashioned, fill the less lesser pelvis with water and insufflate the rectal stump with air or perform rectoscopy. There should be no air bubbles because this would imply suture line leakage. In such cases, find the leak and oversew it. In persistent leakage consider loop ileostomy. Re-anastomosis as a last resort.