Leakage is a problem largely confined to anastomoses within 6 cm of the anal verge when optimal surgical technique is exercised. At such low levels, most surgeons now use a combination of linear and circular staplers. The Moran Triple Stapling Technique is our chosen method. Most recently, the simultaneous use of two linear staplers to seal the specimen and wash the distal stump is a rapid technique for anastomosis onto the dentate line within the external sphincter. Proximal defunctioning and the short colon pouch with side-to-end colo-anal anastomosis are currently considered optimal. A trial is under way to assess a silastic transanal stent as an alternative. Ultra-low anastomosis, however, remains potentially hazardous and still should be undertaken only by specialists.
Copyright 2000 Wiley-Liss, Inc.