Definition
"Without mouth" - Joining of one viscus/vessel with another to establish continuity of flow
Types
- End-to-end
- End-to-side (differing sizes of lumens)
- Side-to-side
Uses | Examples |
Notes |
Gastrointestinal | Colorectal Enterocolostomy |
Two layer technique (classical teaching)
- Achieves inversion (low likelihood of anastamotic leakage) Single layer technique (modern teaching)
- Minimal damage to vascular plexus Stapled
- Reduced anastamotic leakage Tissue Glue
Suspection of leakage
|
Urology | Uretero-ureterostomy Ureteric bladder re-implantation Ileal conduit / ileal pouch |
Use absorbable sutures (non-absorbable causes stones) |
Vascular / Cardiothoracics | Coronary artery bypass grafts Fem-pop bypass |
Aim:
Use non-absorbable suture - Everted anastamosis (provides intact endothelial surface, low risk of thrombus)
Complications
|
Transplant | Renal transplant Liver transplant |
|
Plastic surgery | Microvascular anastamosis |
Factors for successful anastamosis
Local |
Blood supply |
Patient | Resuscitated, warm, well perfused Good nutrition |
Surgical | Appropriate sutures Avoidance of watershed areas |