# End to end Triangular Anastomosis using a TA stapler

In many instances, it makes more sense to do an end-to-end anastomosis rather than side-to-side - especially in the large bowel. Here is a technique to create an end-to-end anastomosis using three loads of a TA stapler.

This free PDF is available online - Scroll down to page 9

https://acreditacion-fmc.org/SciAm/segundaconvocatoria/pdf/SCI_26.pdf

#### Does this reduce the bowel lumen?

If you consider a segment of the bowel with a diameter of 2 inches (radius 1 inch), the area of the circle will be 3.14 inches^2, and the perimeter will be 6.2 cm.

Therefore, starting area = 3.14 inch^2

When the anastomosis is converted to an equilateral triangle of 6.2 cm perimeter, the area will be The area of an equilateral triangle can be calculated using the formula:

A = (s^2 * √3) / 4

Where s is the length of a side of the triangle. To find the side length, we need to use the perimeter of the triangle:

P = 3s

So s = P / 3 = 6.2 inches / 3 = 2.067 inches

Now we can use this value of s to find the area of the triangle:

A = (2.067^2 * √3) / 4 = (4.277 * √3) / 4 = 2.132 inches^2

So the area of an equilateral triangle with a perimeter of 6.2 inches is approximately 2.132 square inches.

Therefore, the lumen is narrowed by 37%. So I would not recommend using this approach on the small bowel.

## Surgical Video demonstrating the technique.

The patient is a 67-year-old with endometrioid endometrial cancer with isolated recurrence involving the descending colon right below the splenic flexure.