**3.1 Manual versus mechanic**

The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction, which potentially contributes to early anastomotic dehiscence or late anastomotic stricture (**Figures 5** and **6**).

## **3.2 Debating issues of the mechanical colorectal anastomosis**

While 2-row stapling has become normal in low anterior resections (LARs), it has no effect on morbidity or the incidence of AL.

Conducted by Nekliudov [3] is the first prospective, randomized clinical trial that compares the success rate of modern 3-row circular staplers to that of traditional 2-row staplers.

According to the hypothesis, the frequency of AL in the 3-row stapler group is not significantly higher than in the 2-row stapler group.

**Figure 5.** *Linear surgical stapler.*

**Figure 6.** *(a and b) circular stapling device and its mode of appliance.*

The rate of AL, as determined by imaging studies and measured using the Pearson chi-squared test and Fisher exact test, is the primary endpoint.

Secondary outcomes include AL severity (A, B, or C), anastomotic bleeding, postoperative complication rate (graded using the Clavien-Dindo classification), reintervention rate, stapler dysfunction rate, complications of nonfunctioning stoma, overall and cancer-specific quality of life (measured using short-form (36) questionnaire and quality-of-life (30) questionnaire core, respectively), fecal incontinence, and overall and cancer-specific quality of life.

Following the LAR, both patients will be tracked for a period of 12 months. This is the first prospective randomized trial to look at the efficacy of 3-row staplers for colorectal anastomosis following rectal cancer surgery.

*The Problem of the Colorectal Anastomosis DOI: http://dx.doi.org/10.5772/intechopen.100302*

**Figure 7.** *2-row staple lines.*

**Figure 8.** *3-row staple lines.*

It could show that 3-row circular staplers are feasible in LAR in terms of shortand long-term patient outcomes (**Figures 7** and **8**).
