Ho, Yik-hong (2008) Salvaging a linear staple line defect in ultra-low anterior resection. Techniques in Coloproctology, 12 (1). p. 73.

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Abstract

[Extract] Dear Sir, Tan et al. [1] described an excellent technique in salvaging a defect in the linear stapler line at the ultra-low anterior resection distal anorectal sump [1]. Hand suturing the defect faciliated the inclusion of the former into the donut of the intraluminal stapler to enable a safe and effective double cross stapled anastomosis [2]. I have used this technique on a few occasions previously and can confirm that this is the case. Recently, I found that this technique was also suitable with linear stable line defect at laparoscopic ultra-low anterior resection in an obese male patient with a narrow pelvis. The rectal stump closure sutures were placed by intracorporeal suturing, thus avoiding a conversion which might have affected the non-eventful rapid postoperative recovery.

At open surgery, the technique I usually use differs slightly in that I leave the rectal stump salvage sutures long. Pulling on these sutures gently will help to 'cone' the defect so that it will be included into the double cross stapled intraluminal stapler donut. The long sutures would be closed over by the jaws of the intraluminal stapler and subsequently cut at stapler firing without any problems.

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