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Anastomosis technique, gastrointestinal, with circular stapler - general and visceral surgery
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Resecting the rectum
Dissecting the wall of the descending colon
Arming the proximal stump with a purse-string suture
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.
Inserting the stapler transanal
Connecting anvil and staple housing
Approximating the stumps and firing the device
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.
Checking the anastomotic donuts
Leakproof testing the anastomosis
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.