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      Reverse Transrectal Stapling Technique Using the EEA Stapler: An Alternative Approach in Difficult Reversal of Hartmann’s Procedure

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          The introduction of circular end-to-end stapling devices (CEEA OR EEA stapler) into colorectal surgery have revolutionised anastomotic techniques. The EEA stapler is generally regarded as an instrument that is safe, reliable, and simple to operate. Despite it’s popularity, very little information is available regarding the technical difficulties encountered during surgery. The routine technique to perform an end-to-end circular colonic anastomosis is to introduce the instrument distally through the anus (transrectal/transanal approach) and attach it to the anvil which is purse stringed at the distal end of the proximal bowel to be anastomosed. Two cases of reversal of Hartmann’s procedure for perforated diverticulitis are described in the present study, where difficulty was experienced while using the EEA stapler in the routine method. Hence, an alternative reverse technique which was used is presented.

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          Most cited references 10

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          A stapling instrument for end-to-end inverting anastomoses in the gastrointestinal tract.

          A stapling instrument is described for end-to-end inverting anastomoses applicable principally to low rectal anastomosis or esophagogastric or esophagojejunal anastomosis. The instrument creates an inverting anastomosis held by a double staggered row of stainless steel wire staples creating an anastomosis 21.2 mm internal diameter with no significant inverted flange. The early experience is encouraging.
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            New techniques of gastrointestinal anastomoses with the EEA stapler.

            A new instrument for accomplishing inverted stapled anastomoses in the gastrointestinal tract is described. Side-to-side, end-to-side and end-to-end anastomoses can be performed. Techniques developed for utilization of the instrument in virtually all gastrointestinal anastomoses are described. In most instances a proximal or distal enterotomy is required. Experience with 57 anastomoses in 42 patients is reported. One leak occurred; no other complications not recognized intraoperatively were observed. Anastomoses completed included gastroduodenostomy, gastrojejunostomy, cholecystojejunostomy, colocolostomy and ileocolostomy. Hazards and complications associated with the use of the instrument are described. It should be used only after the surgeon has acquired the skills to operate the instrument properly. The instrument saves time, creates better anastomoses than can be obtained by hand sewing and is extremely versatile. It may permit safer anastomoses in adverse conditions, such as in obstruction and peritonitis. The instrument opens new horizons in gastrointestinal surgery.
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              Hümer Hültl: the father of the surgical stapler.


                Author and article information

                J Surg Tech Case Rep
                Journal of Surgical Technique and Case Report
                Medknow Publications (India )
                Jul-Dec 2010
                : 2
                : 2
                : 70-72
                Department of Surgery, MOSC Medical College, Kolenchery, Cochin, India
                Author notes
                Address for correspondence: Dr. Sanoop Koshy Zachariah, Department of Surgery, MOSC Medical College, Kolenchery, Cochin - 682 311, India. E-mail: skzach@ 123456yahoo.com
                © Journal of Surgical Technique and Case Report

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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