Staple Suturing of the Colon

To the Editor .–I wish to reinforce the observations made by Brodman and Brodman in their article "Staple Suturing of the Colon Above the Peritoneal Reflection" (Archives1981;116: 191-192). Essentially, their experience in 88 reported cases is similar to mine in a personal series of 468, performed by one surgeon with the assistance of residents. Of the 468 cases, there were two deaths that could be directly attributed to anastomotic disruption. There were four anastomotic problems in the variety of cases, which included 83 gastric resections, 81 gastrojejunostomies, seven cholecystojejunostomies, 43 jejunojejunostomies, 81 small-bowel resections with anastomoses, 154 colon resections, and 19 colostomy closures. Like those of the authors, all anastomoses were fashioned with the gastrointestinal (GI) anastomosis (GIA) and the thoracoabdominal (TA) stapling instruments. All colon and small-bowel anastomoses were performed via Steichen's side-to-side functional end-to-end technique. A second-hand sutured layer was rarely if ever used; however, a reinforcing