2003 年 28 巻 2 号 p. 251-256
In 1968 Steichen described a method of anastomosis called “functional end-to-end anastomosis” in which a linear anastomosis device and linear suture device were used to create a side-to-side anastomosis anatomically. We assessed the usefulness of a 100 mm linear stapler to perform functional end-to-end anastomosis during open surgery in 153 cases of advanced colon cancer. There have already been several reports on this technique, our own experience shed light on the following problems and points concerning the technique which have not been reported previously. First, the stump at the blind end must be buried with purse-string sutures, because the blind end on the proximal side in particular is exposed to the greatest pressure. Second, in left hemicolectomies the anastomotic portion often lies over the ligament of Treitz, and by raising it with 2-3 sutures on the gastric side, the anastomotic portion comes to rest in a more physiological position. Third, in sigmoidectomies, if the cutter is fired with the inverted opposite antimesenteric sides turned inward as in the conventional method, the anastomosis sometimes comes to lie immediately to the left of the aorta, whereas if the cutter is fired with the inverted opposite anti-mesenteric sides turned outward, the anastomosis often comes to rest in a more physiological position. The duration of the anastomosis procedure was approximately 5 to 8 minutes, there were no particularly major complications. This is a very useful method not only in gastrointestinal surgery, but in other disciplines as well.