Section: Colorectal and Operation
Sub-section: Stapled anastomosis
Joshes stapled anastomosis
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Grasp near the stapled end with a Babcock at the antimesenteric border
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Make a small enterotomy on the bowel with diathermy
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Fire the stapler - as you pull it out, open it and check for bleeding
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close the common enterotomy with running 4-0 PDS in line with the staple line. Place a stay stitch on the side close to you and then start a new stitch away from you and suture towards yourself and tie to the stay.
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Crotch stitch Colorectal Surgery A Companion to Specialist Surgical Practice 1, page 175
Joshes tip for the direction you bring the small bowel around to meet the colon when creating an anastomosis. Draw an oblique line along the root of the small bowel mesentery. If the anastamosis is to the patients right of this then come clockwise. If it is to the patients left of this then instead come anticlockwise.
