What is the process for restoration of bowel continuity after intestinal resection or injury, also known as intestinal (bowel) anastomosis?

From the Guidelines

Restoration of bowel continuity should be accomplished as soon as safely possible in patients with short bowel syndrome to improve bowel function and reduce the risk of or decrease parenteral nutrition dependency. This approach is supported by the most recent evidence from the AGA clinical practice update on management of short bowel syndrome, which emphasizes the importance of restoring intestinal continuity to improve patient outcomes 1.

Key Considerations

• The decision to restore bowel continuity should be made on a case-by-case basis, taking into account the individual patient's condition and the surgeon's technical abilities 1.
• A multidisciplinary approach to care is recommended for patients with short bowel syndrome, including dedicated surgical expertise, to optimize intestinal rehabilitation and overall patient outcome 1.
• Preoperative preparation, including mechanical bowel preparation, prophylactic antibiotics, and venous thromboembolism prophylaxis, is crucial to minimize the risk of complications.
• The surgical approach may be open or laparoscopic, with the latter offering faster recovery and less pain.

Surgical Techniques

• The choice of anastomotic technique, whether handsewn or stapled, should be individualized to the patient's condition and the surgeon's technical abilities 1.
• In patients with short bowel syndrome, intestinal tapering and lengthening operations, such as the longitudinal intestinal lengthening and tapering (LILT) operation or the serial transverse enteroplasty (STEP) operation, may be considered to improve bowel function and reduce parenteral nutrition dependency 1.

Postoperative Care

• Close monitoring for complications, such as anastomotic leak, bleeding, or infection, is essential in the postoperative period.
• Most patients can resume oral intake within 24-48 hours following a progressive diet advancement protocol.
• Recovery typically takes 2-4 weeks, with bowel function normalizing gradually over several months as the body adapts to the restored continuity.

From the Research

Restoration of Bowel Continuity

• Restoration of bowel continuity is a surgical procedure that can be performed after various abdominal surgeries, including Hartmann's procedure, colectomy, and rectal cancer surgery 2, 3, 4, 5.
• The procedure can be performed using different techniques, such as laparoscopic reversal of Hartmann's procedure, stapled or hand-sewn anastomosis, and colonic J-pouch-anal anastomosis 3, 5.
• The outcomes of restoration of bowel continuity can vary depending on the underlying condition and the surgical technique used. For example, a study found that laparoscopic reversal of Hartmann's procedure had a low morbidity rate of 10% and no postoperative mortality 3.
• Another study found that restoration of bowel continuity after colectomy for non-occlusive ischemic colitis had an overall morbidity rate of 45% and no postoperative deaths 4.
• The procedure can also improve bowel function and quality of life for patients with rectal cancer, with techniques such as colonic J-pouch-anal anastomosis and coloplasty-anal-anastomosis showing promising results 5.
• Additionally, restoration of bowel continuity can allow patients to stop parenteral nutrition (PN) after a bowel resection for mesenteric infarction, with one study finding that PN was stopped within 1 year in 35% of patients and within 5 years in 77% of patients 6.

Predictive Factors and Complications

• Predictive factors for restoration of bowel continuity can vary depending on the underlying condition. For example, a study found that patients taking immunosuppressant drugs had significantly more wound infections after restoration of bowel continuity 2.
• Complications of restoration of bowel continuity can include surgical infections, anastomotic leakage, and medical complications such as pneumonia and urinary tract infections 2, 3, 4.
• The administration of PRBC and a prolonged hospital stay can also be associated with increased postoperative morbidity 2.

Surgical Techniques and Outcomes

• Laparoscopic techniques for restoration of bowel continuity are being proven to be effective, with studies showing low morbidity rates and fast recovery times 3, 5.
• The choice of surgical technique can depend on the underlying condition and the surgeon's experience, with techniques such as colonic J-pouch-anal anastomosis and coloplasty-anal-anastomosis showing promising results for improving bowel function and quality of life 5.