What is an anastomosis?

From the Guidelines

Anastomosis is a critical surgical procedure that involves creating a connection between two structures, such as blood vessels or sections of the intestine, to restore flow and function, with the goal of minimizing morbidity, mortality, and improving quality of life. In the context of bowel injury, anastomosis is preferred over diversion to restore intestinal continuity, but it carries a risk of anastomotic leak, which can significantly increase mortality, as reported in a study published in the World Journal of Emergency Surgery in 2022 1. The decision to perform an anastomosis should be based on careful consideration of the risks and benefits, taking into account factors such as the location of the anastomosis, the presence of other injuries, and the patient's hemodynamic status. Some key points to consider when evaluating the risk of anastomotic leak include:

• The location of the anastomosis, with more distal anastomoses having higher leak rates, as reported in a study that found leak rates of 17%, 25%, and 50% for right, transverse, and descending colon anastomoses, respectively 1
• The timing of the anastomosis, with delayed primary anastomoses having higher leak rates than primary anastomoses, as reported in a study that found leak rates of 18% versus 10% 1
• The use of negative pressure therapy, which can affect anastomosis healing and increase the risk of leak, as reported in a study that found leak rates of 6% versus 27% in closed versus open abdomens, respectively 1
• The importance of achieving fascial closure within five days to minimize the risk of anastomotic leak, as reported in a study that found leak rates of 18% versus 2% in patients with delays to fascial closure of more than five days versus less than five days, respectively 1. Overall, the goal of anastomosis is to restore function and minimize morbidity and mortality, and the decision to perform an anastomosis should be based on a careful evaluation of the individual patient's risks and benefits.

From the Research

Definition of Anastomosis

• Anastomosis refers to a surgical connection between two structures, such as blood vessels, intestines, or other tubular structures, to restore continuity or create a new pathway for flow 2, 3, 4, 5, 6.

Types of Anastomosis

• There are different types of anastomosis, including:
  • Stapled anastomosis: uses a mechanical stapling device to connect the structures 2, 3, 6.
  • Hand-sewn anastomosis: uses sutures to connect the structures 3, 4, 6.
  • Single-layer anastomosis: uses a single layer of sutures to connect the structures 4.
  • Double-layer anastomosis: uses two layers of sutures to connect the structures 4.

Complications of Anastomosis

• Anastomotic complications can occur, including:
  • Leakage: a leak at the anastomotic site 2, 3, 6.
  • Stricture: a narrowing of the anastomotic site 2, 3, 6.
  • Bleeding: bleeding at the anastomotic site 2, 5.
  • Device failure: failure of the stapling device or sutures 2.

Techniques to Reduce Complications

• Techniques to reduce anastomotic complications include:
  • Using biologic materials to reinforce the anastomosis 2.
  • Using knotless barbed sutures to simplify the anastomotic procedure 5.
  • Ensuring proper surgical technique to minimize the risk of complications 6.