Coloanal anastomosis (CAA) is used to preserve anal defecation after proctectomy. It is a savior technique when there are difficulties while performing low rectal anastomosis.   The aim of the study: was to highlight some of the indications, technique and the outcomes of CAA to raise the awareness of the young generations to use it when needed.   Patients and methods: This was a retrospective study that included 21 patients that had proctectomy and hand-sewn CAA with covering loop ileostomy. Full history, preoperative examination, operative details, and the follow-up notes were collected from our sheets. All patients were operated on by the same team of surgeons using the same technique. Closure of ileostomy was performed two to six months after the primary procedure.   Results: Out of the 21 patients, eight (38%) had benign lesions, whereas 13 (61.9%) had low rectal tumors. Pelvic abscess and complete dehiscence of the anastomosis, burst abdomen, and dehydrarion and renal impairment each occurred in one patient (4.76%). Three patients (14.3%) developed anastomotic stenosis and four (19%) developed mild to moderate incontinence. Two patients developed radiological leak (9.5%) that was observed via thin enema study after the 6th postoperative week and disappeared after the 12th week. All patients had a good quality of life after reversal of the stoma.   Conclusion: There is a time intra-operatively that a colorectal surgeon has to accept that stapled anastomosis is not feasible and should change to hand-sewn CAA as it could be the safest solution for many intra-operative anastomotic problems.