Anastamosis

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) Full-thickness "all coats" continous suture - catches strong submucosa Seromuscular interrupted suture (Lembert stitch) - Achieves inversion (low likelihood of anastamotic leakage) - Inner layers haemostatic but prone to stangulation Single layer technique (modern teaching) Interrupted seromuscular extramucosal suture on round-bodied needle - Minimal damage to vascular plexus - may cause less tissue trauma Stapled Linear: creates side-to-side anastamosis Inserts 4 parallel linear rows and cuts in the middle Circular: Unites bowel end-to-end - Reduced anastamotic leakage - Increased strictures Tissue Glue Suspection of leakage Unexplained pyrexia Tachycardia Prolonged ileus 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: Permanently establish flow 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 Bleeding / leakage / pseudoaneurysm Stenosis Thrombosis 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

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