3. INTRODUCTION
⢠The word anastomosis comes from the Greek âanaâ, without, and
âstomaâ, a mouth, i.e. when a tubular viscus (bowel) or vessel is joined
after resection or bypass without exteriorisation with a stoma.
⢠Intestinal anastomosis is the surgical connection of separate or
severed bowel to form a continuous channel.
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4. INTRODUCTION
⢠Early phase (0â4days): There is an acute inflammatory response, but
no intrinsic cohesion.
⢠Fibroplasia (3â14days): Fibroblast proliferation occurs with collagen
formation.
⢠Maturation stage (>10 days): This is the period of collagen
remodeling, when the stability and strength of the anastomosis
increase
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5. TYPES
⢠Orientation of bowel
⢠Side-to-side
⢠End-to-end
⢠End-to-side
⢠Technique
⢠Hand sewed
⢠Stapling technique
⢠Part of the bowel involved
⢠Gastro-jejunostomy
⢠Jejuno-jejunostomy
⢠Ileo-colic anastomosis
⢠Base on the number of layers
⢠Single
⢠Double layer
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8. Intra-operatives
⢠Anesthesia
⢠GA and muscle relaxation
⢠Maintenance of good perfusion and tissue oxygenation
⢠Adequate access and exposure
⢠Lightening
⢠Assessment of Viability of bowel
⢠Prevention of spillage - Clamping
⢠Avoid clamping or suturing mesenteric vessels
⢠Decompression
⢠Blood supply- bright red bleeding from cut edge
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13. SINGLE LAYER ANASTOMOSIS
⢠An interrrupted seromuscular suture, with absorbable thread. The
submucosal layer is strong and the blood supply is only minimally
damaged
⢠Lembert stitch
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16. DOUBLE LAYER ANASTOMOSIS
⢠An inner continuous absorbable
suture, with stitching of all
layers
⢠An outer, seromuscular,
interrupted nonabsorbable
suture
⢠Serosa apposition and mucosa
inversion; the inner layer has a
hemostatic effect, but the
mucosa is strangulated
⢠Connell stitch- continuous
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21. Stapler-made anastomosis
⢠This can be a side-to-side anastomosis with a straight sewing machine
(e.g. GIA = gastrointestinal anastomosis staplers).
⢠It can be an end-to-end anastomosis with a circular machine (e.g.
CEEA = circular end-to-end anastomosis stapler).
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27. ⢠Traditionally ---inversion
⢠Allows mucosal apposition
⢠ignores the base principles of accurately opposing clean-cut tissues
⢠Eversion
⢠Study reported greater anastomotic strength, less luminal narrowing less
oedema and inflammation with everted small bowel anastomosis
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28. N-G tube ;
⢠in retrospective and prospective, randomized controlled trials routine use of
NG tube conferred no significant advantage
⢠There was a trend of increase incidence of respiratory tract infection with
gastric decompression.
⢠A study showed that 20% of patient required NG tube post operatively
following gastric dilatation.
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29. ⢠Abdominal drains
⢠Collection around the anastomosis impair healing and leads to leakage
⢠Many surgeons place drain after anterior resection or colo-anal anastomosis
because of risk of fluid collection
⢠a 1999 study of pelvic drainage after rectal or anal anastomosis showed
that prophylactic drainage did not improve outcome or reduce complication
⢠One study showed a dramatic increase in the incidence of anastomotic
dehiscence (15% to 55%) after placement of perianastomotic drain in dogs
⢠Another study showed inflammation around the anastomosis
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30. CONCLUSION
⢠Successful bowel anastomosis is attributed to adequate knowledge
on intestinal healing, patient optimization, meticulous surgical
technique and good post operative care.
⢠This is achieved by constant practice
⢠A complicated anastomosis is associated with increase morbidity and
mortality as much as 10 fold and doubles length of hospital stay
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31. References
⢠Bailey and Loves short practice of surgery, 25th edition
⢠Khatri: Operative Surgery Manual, 1st ed
⢠Kirkâs general surgery operations 6th edition
⢠Farquharsonâs textbook of operative general surgery 9th edition
⢠Boros surgical technique
⢠SRBâs surgical operation text and atlas 1st edition. 2014
⢠www.emedicine.emedcape.com
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