Progressive release of the left colon for a tension-free colorectal or coloanal anastomosis.

The technical flaws that result in a leak from a low colorectal or a coloanal anastomosis are inadequate blood supply and tension on the suture line. An adequate blood supply is dependent on a patent and nontraumatized marginal artery. Lack of tension is achieved by gaining added length from the left colon through the release of its abdominal attachments. This chapter describes the maneuvers that allow progressive release of the left colon to provide a tension-free anastomosis to the low rectum, even with extensive resections of the sigmoid colon and portions of the descending colon. In most instances a well-vascularized and tension-free stapled anastomosis does not require a diverting ostomy. These maneuvers will result in a safer and less expensive colorectal resection.