Ligation device assisting low anterior anastomosis.

Abstract

The use of the circular stapler has enabled surgeons to perform very low anterior resections where previously abdominoperineal proctectomy would be performed for carcinoma of the rectum. The use of the roticulator or other linear stapler devices has facilitated these anastomoses and precluded the necessity for pursestring sutures, thereby reducing the incidence of incomplete tissue rings, which should reduce the risk of anastomotic leaks. One significant drawback to the roticulator, especially in the narrow male pelvis, is its application for very low lesions. In many cases the stapler cannot be forced deeply enough into the pelvis to allow for a sufficient margin below the tumor. The purpose of this article is to report results of a prototype that applies a gasket that automatically fixes the rectum to the rod of the circular stapler. To date the device has been used 22 times in 14 patients (8 patients had both limbs attached using the device, whereas 6 patients had only the rectal stump attached in this manner). All anastomoses healed without complication, all patients had complete donuts of tissue, and only two anastomoses had to be reinforced. The use of this device may facilitate stapling of very low anastomoses for carcinoma of the rectum.