Anastamosis

Definition
"Without mouth" - Joining of one viscus/vessel with another to establish continuity of flow

 

Types

  1. End-to-end
  2. End-to-side (differing sizes of lumens)
  3. Side-to-side 

 

Uses Examples
Notes 
Gastrointestinal Colorectal
Enterocolostomy

Two layer technique (classical teaching)

  1. Full-thickness "all coats" continous suture - catches strong submucosa
  2. Seromuscular interrupted suture (Lembert stitch)

- Achieves inversion (low likelihood of anastamotic leakage)
- Inner layers haemostatic but prone to stangulation

Single layer technique (modern teaching)

  1. Interrupted seromuscular extramucosal suture on round-bodied needle

- Minimal damage to vascular plexus
- may cause less tissue trauma

Stapled

  1. Linear: creates side-to-side anastamosis
    • Inserts 4 parallel linear rows and cuts in the middle
  2. Circular:
    • Unites bowel end-to-end

- Reduced anastamotic leakage
- Increased strictures

Tissue Glue

 

Suspection of leakage

  1. Unexplained pyrexia
  2. Tachycardia
  3. Prolonged ileus
  4. GI contents in drain 
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:

  1. Permanently establish flow
  2. Avoid intimal disruption and turbulence
    • Pass needle within outwards
    • Smooth intimal suture line
    • Eversion of anastamosis 

Use non-absorbable suture

- Everted anastamosis (provides intact endothelial surface, low risk of thrombus)

 

Complications

  1. Bleeding / leakage / pseudoaneurysm
  2. Stenosis
  3. Thrombosis
  4. Distal embolism 
Transplant Renal transplant
Liver transplant
 
Plastic surgery Microvascular anastamosis  

 

Factors for successful anastamosis

Local

Blood supply
Tension-free
Good approximation
No distal obstruction

Patient Resuscitated, warm, well perfused
Good nutrition
Surgical Appropriate sutures
Avoidance of watershed areas