Principles of Bowel Anastomosis with Videos

2 mn read

Milestones in the history of intestinal anastomosis

Intestinal anastomosis has been successfully performed for more than 150 years using a variety of techniques and suture materials. Major milestones in the development of this technique are:

Lembert : Seromuscular suture technique for bowel anastomosis in 1826

Kocher : Utilised a two-layer anastomosis. First a continuous all-layer suture using catgut, then an
inverting continuous (or interrupted) seromuscular layer suture using silk

Halsted : Favoured a one layer extramucosal closure, it was felt to cause the least tissue necrosis or
luminal narrowing. This technique has now become widely accepted.

Currently accepted technique for intestinal anastomosis

Of these, the method that has proven successful in most situations and in the hands of most surgeons has been the two-layer anastomosis using interrupted silk sutures for an outer inverted seromuscular layer and a running absorbable suture for a transmural inner layer.

The only appreciable shortcoming of the two-layer technique is that it is somewhat tedious and time-consuming to perform. Recently, several reports have appeared advocating a single-layer continuous anastomosis using monofilament plastic suture.

Single layer continuous extramucosal closure has now become widely accepted.

A single-layer continuous anastomosis can be constructed in significantly less time and with a similar rate of complications compared with the two-layer technique. It also costs less than any other method and can be incorporated into a surgical training program without a significant increase in complications.

Single Layer , Extramucosal, Interrupted- End to End bowel anastomosis (simulation)

Side to side bowel anastomosis (simulated)

Difference between Extramucosal Technique and Seromuscular Suture Technique

The extramucosal suture must include the submucosa as this has a high collagen content and is the most stable suture layer in all sections of the gastrointestinal tract.

Suture Materials used in Intestinal Anastomosis

Catgut and silk have been replaced by synthetic, usually absorbable, polymers.

The suture materials should be of 2/0–3/0 size and made of an absorbable polymer, which can be braided (e.g. polyglactin), or monofilament (e.g. polydioxanone), mounted on an atraumatic round-bodied needle. 

Suture bites should be approximately 3–5 mm deep and 3–5 mm apart depending on the thickness of
the bowel wall.
Stay sutures are put to avoid the need for tissue forceps. They are important for displaying the bowel
ends and in accurate alignment of the bowel and the placement of the sutures.

Important Considerations while doing Bowel Anastomosis

In cases of major size discrepancy of size of bowel end to be anastamosed, a side-to-side or end-to-side anastomosis is done.

In cases of minor size discrepancy, Cheatle split (making a cut into the antimesenteric border) may
help to enlarge the lumen of distal, collapsed bowel and allow an end-to-end anastomosis to be fashioned.

Related Books

Leave a Reply if you have any queries or suggestions.

Do more at World Surgery Forum
Explore More Surgery Topics You Like

Best Surgery Books

BEST BOOKS FOR MRCS PART A

  1. MRCS Part A: Essential Revision Notes: Book 1
  2. MRCS Part A: Essential Revision Notes: Book 2
  3. MRCS Practice Papers Part A: Paper 1 SBAs
  4. MRCS Practice Papers Part A: Paper 2 EMQs
  5. Rush University Medical Center Review of Surgery
  6. Bailey & Love Companion Guide Mcqs & Emqs In Surgery
  7. SBA MCQs and EMQs for the MRCS Part A Pack: 2
  8. Basic Science for the MRCS: A revision guide for surgical trainees
  9. Oxford Handbook of Clinical Surgery
  10. Get Through MRCS Part A: SBAs
  11. Mrcs Module 2016 Question With Explanations For Mrcs The Best Question Series
  12. EMQs and Data Interpretation Questions in Surgery

BEST BOOKS FOR MRCS PART B

  1. DrExam Part B MRCS OSCE Revision Guide: Book 1
  2. DrExam Part B MRCS OSCE Revision Guide: Book 2
  3. OSCEs for the MRCS Part B: A Bailey & Love Revision Guide
  4. Succeeding in the MRCS Part B Exam: Essential revision notes for the OSCE format
  5. Get Through MRCS: Anatomy 2E
  6. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors by Harold Ellis
  7. Essential Radiological Anatomy for the MRCS
  8. Surgical Critical Care: For the MRCS OSCE by Mazyar Kanani and Simon Lammy
  9. Surgical Critical Care Vivas by Mazyar Kanani
  10. Mcminn’s Color Atlas of Human Anatomy
  11. Netter’s Atlas of Human Anatomy

 

BEST MCQ BOOKS FOR GENERAL SURGERY

  1. Surgery Essence By Pritesh Singh
  2. Surgery Sixer for NBE by Rajamahendran 4th ed (2019)
  3. Bailey & Love Companion Guide Mcqs & Emqs In Surgery
  4. Schwartz’s Principles of Surgery ABSITE and Board Review
  5. Surgery PreTest Self-Assessment and Review, 13th ed
  6. SURGERY COMPLETE – 2019
  7. Surgery For PGMEE 13th Edition – 2019 by Amit Ashish

BEST TEXTBOOKS FOR GENERAL SURGERY

  1. Bailey & Love’s Short Practice of Surgery, 27th Edition
  2. Sabiston’s Textbook of Surgery
  3. Schwartz’s Principles Of Surgery
  4. SRB’S Manual Of Surgery

BEST BOOKS FOR OPERATIVE SURGERY

  1. Operative Techniques in Surgery by Michael W. Mulholland et al
  2. Chassin’s Operative Strategy in General Surgery
  3. Farquharson’s Textbook of Operative General Surgery, 10th Edition

"To be great, a surgeon must have a fierce determination to be the leader in his field. He must have a driving ego, a hunger beyond money. He must have a passion for perfectionism. — Donald B. Effler"

World Surgery Forum – Disclaimer
The information given on this page is for educational purposes only and should not be a substitute for professional medical advice. Do not use this information to diagnose or treat your problem without consulting your doctor. This site respects copyright and does not offer any free ebook downloads. The site and posts may contain amazon links of surgery books and products we love.
Subscribe to WSF via Email

Enter your email address to subscribe and receive notifications of new posts by email.

Join 27,909 other subscribers

%d bloggers like this: