The Intestinal Anastomosis With the End-to-End Stapling Instrument

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Abstract
In 1977, a stapling instrument for circular, inverted, stapled end-to-end anastomosis (EEA) was introduced for clinical use in the United States. Primarily designed for low colorectal anastomoses, the EEA instrument is also used at other sites, including esophagus, stomach, and small intestine. The surgical technique has been described in detail in several recent reports by Goligher et al,1Nance,2and Ravitch and Steichen.3 BACKGROUND The device has a host of interesting forebears. In the 12th century, Roger of Palermo is said to have performed intestinal anastomoses over thin tubes of elder. In 1892,4John B. Murphy introduced his "Murphy Button" for joining divided portions of the intestinal tract without suture. W. S. Halsted, in 1910,5introduced a concept and a prototype instrument remarkably similar to the modern instrument6for his so-called bulkhead anastomosis; but lacking modern technology, he never carried it beyond the experimental stage.