Vertical division of the rectum by endostapler in very low colorectal anastomosis with a double-stapling technique

Application of standard linear staples can sometimes be difficult in a narrow pelvis of small male patients, or in deep colorectal anastomosis, even using improved double-stapling techniques (DST). A modified DST, using an endostapler, by vertical division of the rectum, instead of the usual horizontal division, under a newly devised position, facilitates easy and steady transection of the rectum, even in the narrow pelvis or with very low anastomosis. Vertical transaction of the rectum, followed by circular stapler anastomosis, forms a vertically ellipsoid anastomotic orifice, which might be more physiological to the vertically shaped anal canal, especially in very low anastomosis.