Anastomosis to the rectum

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Abstract
Consecutive procedures involving anastomosis to the rectum (466) were performed between March 1969 and Dec. 1982. Three hundred ninety-six (85%) were stapled anastomoses and 70 (15%) were hand-sutured anastomoses. The stapled anastomoses were constructed using the GIA or EEA instrument, some of the latter utilizing a pull-through technique. The hand-sutured anastomoses were constructed in the pelvic space, or externally as a staged pull-through procedures, in 47 of 56 (84%) conventional hand-sutured anastomoses, and in 38 of 396 (10%) stapled anastomoses. While the majority of very low anastomoses (0-5 cm from the dentate line) were stapled, 13 conventional hand-sutured anastomoses and all 14 of the staged pull-through procedures were constructed at this level. One patient (0.2%) died as the result of an anastomotic complication. Twelve patients (2.5%) had anastomotic complications requiring reoperation. The reoperation rate for stapled anastomoses was 6 of 396 (1.5%). For hand-sutured anastomoses, the reoperation rate was 6 of 70 (8.6%). For anastomosis to the rectum, stapling instruments are apparently at least as good as hand-suturing. Both stapling techniques and hand-suturing techniques provide the surgeon the capacity to construct safely very low anastomoses. A temporary, diverting stoma is required much less frequently with stapled than with hand-sutured anastomoses. The need for a permanent colostomy should be determined by the stage and level of disease, the systemic health of the patient and the patient''s anatomy, rather than by the selection of anastomotic technique.