Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Bowel anastomoses
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Anastomoses
Definition: the surgical connection of separate or severed tubular hollow organs to form a continuous channel (e.g. bowel to bowel, ureter to bowel, artery to artery).
Techniques
Hand-sewn
Stapled.
Currently there is no evidence to suggest that either is superior to the other, providing attention is paid to factors that influence successful healing of anastomoses.
Types of anastomosis (Figure 152)
Hand-sewn bowel anastomoses use absorbable suture material (e.g. Vicryl, polydioxanone (PDS)) and aim to invert sutured edges. Sutures can be interrupted or continuous. Previously, the two-layer technique was employed, when a full thickness suture layer was created, followed by a second seromuscular layer (see Figure 155) that buried the first suture line. Now, a single-layered anastomosis is advocated. This incorporates an inversion of the sero-submucosal layer, again using an absorbable material (e.g. Vicryl).
Vascular anastomoses use non-absorbable suture material (e.g. Prolene). Suturing is continuous in order to provide an equal distribution of tensile strength throughout the anastomotic line. As opposed to bowel anastomoses, vascular suturing aims to evert the anastomotic edges.
Stapling devices
These are commercially available disposable devices. They consist of a ‘gun’ that has a stapling mechanism and a cutting mechanism.
CIRCULAR STAPLING (E.G. CEEA CIRCULAR ENDOSCOPIC ANASTOMOTIC STAPLER)
For end–end anastomoses. Two ends of bowel are physically apposed within the staple gun. When fired, the gun forms two circular rows of staples joining the two bowel ends. Two ‘doughnuts’ of excess tissue are then cut with the gun's knife.
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- Hospital SurgeryFoundations in Surgical Practice, pp. 680 - 682Publisher: Cambridge University PressPrint publication year: 2009