The Duhamel procedure has been the most popularly performed procedure worldwide because of its technical ease and the concept to preserve the perirectal nerves. However, fecaloma formation due to rectal blind pouch and residual spur had been the most bothersome complication.
Z-shaped anastomosis is one of the modifications of Duhamel procedure that was designed to eliminate the rectal blind pouch and to achieve complete resection of the colorectal septum.
This anastomosis is composed with three anastomotic lines: (1) the lower part, end-to-end anastomosis of the posterior wall at dentate line; (2) upper part, end-to-end anastomosis of the anterior wall at pelvic floor; and (3) middle part, a longitudinal side-to-side anastomosis with stapling. The lateral view of this anastomosis shows a “Z”-shaped suture line, so this procedure has been named Z-shaped anastomosis.
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