Walker Teynolds, Jr., M.D.
327 East Tenth Street, P. O. Box 1196, Anniston, Alabama 36201
November 6, 1973
Mark M. Ravitch, M. D., F.A.C.S.
3459 5th Abenue
Pittsburgh, Pennsylvania 15213
Congratulations on a great two days for the workshop in the use of Staplers in Surgery! It was certainly wise of you and Felix to take the course past the class room instructions with movies, slides and lectures into the actual use of the staplers in the dog lab and observing stapler operations in the various hospital operating rooms. It was most interesting to me and quite impressive in that the course had something for everyone including the beginner who had never used the instrument to those of us who had had some experience with them. I personally picked up many “pearls” which will help me improve the techniques that I am now using and help me evaluate the various procedures in which I am using the staplers as well as it has stimulated me in adapting new procedures. When I arrived in Anniston I found a letter from Joe Baker who had requested a reprint of my article “Low Anterior Resection Using an Automatic Anastomosing Instrument” which appeared in the American Journal of Surgery in September of 1972. I used his operation as a reference to a conventional type procedure which would be learned as a prerequisite before using the GIA stapler technique. You would be interested in some of the his comments, “Actually, I think our technique is applicable when the level of resection is lower than that you referred to. I noticed in your pictures you are anastomosing above the cul-de-sac reflection of peritoneum. You are essentially doing a side-to-side anastomosis and closing the two ends. As you say, this permits you to give as a large a lumen as you desire. This advantage, plus the speed of the clips over suturing are notable.
I have been distressed at John Golligher and others who have reported high incidence of leaks in anastomosis of the colon to the rectum low in the pelvis by the end-to end technique. I believe that our method has definitely reduced the incidence of both morbidity and mortality in our hands and in the hands of a number of other surgeons. I think that this is the real test of any procedure and I will follow with interest this yardstick on your procedure when it has been applied in a large number of cases. I would think that the one practical disadvantage in the teaching program is that the resident that does out may not have the advantage of these special instruments and therefore in his training should learn the suture technique