Testing Competence of Rectal Anastomoses

To the Editor.–Engelberg and Reiss of K far Saba, Israel, have described a method of testing the competence of the rectal anastomosis following the use of a circular stapling device (EEA) (Archives 1981;116:482). We have used a similar technique of injecting a povidone-iodine solution through a Foley catheter positioned in the distal portion of the rectum but have found the point of leakage difficult to locate in the very low anterior anastomosis. We have abandoned this practice for one that we believe is superior. After the anastomosis has been completed and hemostasis achieved, sterile normal saline is poured into the pelvic cavity until the anastomotic line is submerged. Using the same syringe and catheter technique as described by Engelberg and Reiss, 50 to 100 cc of air is instilled until the rectum and lower sigmoid colon are gently inflated. We do not finger clamp the proximal sigmoid. If a