Circular anastomosis stapler. An alternative to pursestring suture.

When used with the circular anastomosis stapler, the pursestring suture (PSS) is not always secure, primarily due to esophageal fragility and secondarily due to poor operative exposure. This problem prompted us to develop a simple, rapid technique to replace the PSS. It consists of a total circular ligature of the esophageal wall, which is tightened around the axis of the stapler between the anvil and cartridge. Exposure of the esophagus and introduction of the device are easily done. Anastomosis reliability was shown by the absence of postoperative complications caused by anastomotic leakage in more than 200 consecutive patients.