Attaching the anvil to the circular stapler
The anvil is attached to the circular stapler (which has been passed transanally); the stapler will be closed and fired in the usual fashion.
The anvil of the circular stapler
A. The anvil of the circular stapler is inserted in the proximal end of the bowel (which has been drawn out of the abdomen through an enlarged trocar site). B. The pursestring suture is tied. The bowel is then returned to the abdomen.
The Gastrojejunostomy
The gastrojejunostomy is created by connecting the anvil and shaft of the circular stapler and firing it. (Soper NJ, Swanstrom LL, Eubanks WS, eds. Mastery of Endoscopic and Laparoscopic Surgery. 2d ed. Philadelphia: Lippincott Williams & Wilkins,
Anvil and gastric wall after transoral delivery
The anvil is pulled through the gastric wall after transoral delivery. (Soper NJ, Swanstrom LL, Eubanks WS, eds. Mastery of Endoscopic and Laparoscopic Surgery. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2005. Used by permission.)