To the Editor.—The use of the circular stapling device is increasing for performance of end-to-end anastomoses throughout the gastrointestinal tract. With one firing, the instrument creates a circular inverting anastomosis held by a double staggered row of stainless steel wire staples.1
After intestinal continuity has been established, it is important to verify the integrity of the anastomotic site. This may be difficult to do in low anterior resections or total gastrectomies, since the posterior part of the bowel is not available for visual inspection. It is recommended that the two rings of tissue ("doughnuts") that are brought out by the cartridge of the instrument be inspected. Integrity of the two doughnuts guarantees that the staples have gone through the bowel walls of both ends. However, accidental tearing of the doughnuts when they are removed from the cartridge may cause concern as to the water-tightness of the anastomosis. We
ENGELBERG M, REISS R. A Simple Technique for Verification of the Competence of Gastrointestinal Anastomoses With the Circular Stapling Device. Arch Surg. 1981;116(4):482. doi:10.1001/archsurg.1981.01380160092022
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