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Case 84: Rectal anastomosis

An anastomosis has been performed.

1. What procedure has been performed?

A circular stapled anastomosis. The commonest use for the circular stapler is a transanal rectal anastomosis. This device saves considerable time and is technically easier to use especially in a low rectal anastomosis.

2. What is the name for the tissue that is left on this instrument?

the "doughnuts" - the proximal and distal margins of the anastomosis and therefore the proximal and distal resection margins of the resection. Although these margins are not used typically to gauge adequacy of resection, they should still be sent for histopathological assessment.

3. What is the significance of that tissue forming complete circles?

The ring of the anastomosis is probably deficient if the doughnuts are incomplete. The chance of that anastomosis leaking would be high and this problem would be an indication to redo or at least repair the anastomosis

4. What methods are there for testing a rectal anastomosis?

1. Air test - warm saline fluid in the pelvis, inflate rectum with air using a large syringe and look for bubbles
2. Iodine test - Instill iodine preparation into the rectum and look in the pelvis for extravasation
3. Methylene blue test - same as iodine test
4. Endoscopy - ontable flexible endoscopy

Post operative:
1. Radiologically - Water soluble contrast enema
2. Flexible endoscopy (these should only be used if an anastomotic leak is of clinical concern, to avoid tampering with a new anastomosis)