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Ann R Coll Surg Engl. 2009 May; 91(4): 356–357.
PMCID: PMC2749430


We appreciate the novel technique which Goutos and co-workers have used in performing the colorectal anastomosis using the circular stapler. However, we have some reservations about the technique.

How it is possible to detach the ice cube from the rectum when it was cross-stapled proximally? They have also mentioned that melting the hard ice cube is aided by body temperature – does this not increase the procedure time?

Did the authors bear in mind the effect of sub-zero temperatures in the area of the colorectal anastomoses? What were the effects of freezing and thawing on the rectal mucosa? The authors also claim to have performed this novel technique in 20 resections; it would be useful to know how many had defunctioning stomas.

We feel that the described technique is cumbersome and difficult to use; it adds extra time to the procedure and its effects on anastomotic healing have not been studied.

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