Bowel Anastomosis Options

Question 1

End-To-End

Answer 1

Features:
Attachment of 2 ends of approximately the same sized structures

Notes:
. Best accomplished by a 2-layer closure technique
. Continuous 3-0 absorbable for muscle-to-muscosa anastomosis
. 3-0 silk interrupted sutures for seromuscular closure
. Entire staple line from transection is excised electrosurgically on the distal & proximal ends prior to anastomosis
. Open ends of bowel may be suctioned to remove any residual fecal material prior to anastomosis

Question 2

End-To-Side

Answer 2

Feature:
Attachment of the end of one section of bowel into the side of another section (t-like)

Notes:
. Best accomplished by a 2-layer closure technique
. Continuous 3-0 absorbable for mucosa-to-mucosa anastomosis
. 3-0 silk interrupted sutures for seromuscular closure
. Staple line from transection is removed electrosurgically on the “end” section prior to anastomosis
. Open ends of bowel may be suctioned to remove any residual fecal material prior to anastomosis
. End-To-Side positioning has one oriented at right angle to other to maintain opening

Question 3

Side-To-Side

Answer 3

Feature:
Creation of parallel opening in 2 sections of bowel with anastomosis

Notes:
. Especially good technique between lumens of unequal dimensions
. Best realized with staplers
. Tech. requires opening the bowel minimally to allow passage of the “halves” of the linear cutter into each lumen, followed by activation of the device to divide the bowel, thereby creating a terminal tube pouch twice the diameter of the bowel
. End of the “tube” is closed with a linear stapler

Question 4

Roux-en-Y

Answer 4

Feature:
. Roux-en-Y is a specific technique of anastomosis that allows for a variety of applications in gastric, intestinal, biliary and pancreatic sx.
. Roux-en-Y is used in partial or total gastrectomy, with pancreatic resection, and in sx. of the bile duct, and is an integral part of the Whipple pancreaticoduodenectomy

Notes:
Using the small intestine as an ex., the proximal end of the divided intestine is anastomosed end-to-side to the distal loop & a section of the distal loop is anatomized to another organ of the digestive system such as the stomach, which forms the shape of the letter Y