This document provides an overview of bowel anastomosis, including definitions, types, factors affecting healing, and complications. It defines anastomosis as the surgical connection of separate hollow viscus to form a continuous channel. It describes different types of anastomosis by orientation (side-to-side, end-to-end, end-to-side), technique (hand sewn, stapled), layer (single, double), and anatomy. It discusses factors affecting healing such as patient health, technical execution, blood supply, and tension. Complications include bleeding, leak, intra-abdominal sepsis, and late issues like stricture and obstruction. The conclusion emphasizes knowledge, optimization, technique, postoperative care, and evidence

1. Principles of bowel anastomosis
Advanced Suturing Workshop 2018
30/06/2018
Chea Chan Hooi
Surgeon
Sibu Hospital

2. Content
• Definition
• Types
• Factors
• Complications
• Controversies
• Conclusion

3. Definition
• Anastomosis
– The surgical connection of separate hollow viscus
to form a continuous channel

4. Types
• Orientation
– Side-to-side
– End-to-end
– End-to-side

5. • Technique
– Hand sewn
– Stapled
• Linear
• Circular

6. • Layer
– Single
• Interrupted, seromuscular
• Blood supply in submucosa
is minimally affected
• AKA Lembert stitch
– Double
• Outer
– Seromuscular,
interrupted
• Inner
– Full thickness
– Haemostatic but mucosa
strangulated

7. • Anatomical
– Gastro-jejunostomy
– Entero-enterostomy
– Entero-colic anastomosis
– Colo-colic anastomosis
– Colo-rectal anastomosis
– Colo-anal anastomosis
– Ileo-anal anastomosis

8. Factors affecting anastomotic healing
• Patient factors
• Technical factors
Good blood supply + no tension + meticulous technique

9. Patient factors
• Aging
• Malnourished
• Anaemia
• Ureamia
• DM
• Inotropes
• Steroids
• Smoking
• Alcoholism
• High risk site of anastomosis
• Radiotherapy?
• Male for pelvic anastomosis

10. Technical factors
• Inaccurate seromuscular appostion
• Poor blood supply
– Tension
– Twisting
– Mesenteric haematoma
– Open mesenteric window?
• Distal obstruction
• Faecal contamination

12. Complications
Early
• Bleeding
• Leak
– A no active intervention
– B intervene but no need
laparotomy
– C re-laparotomy
• Intra-abdominal sepsis
Late
• Stricture
• Obstruction

13. Conclusion
• Knowledge on anastomotic healing
• Optimisation of patient & ?surgeon
• Meticulous technique
• Good post operative care
• More evidence showing stapled > sutured
anastomoses

14. TQ!
Q&A?