This document discusses various techniques for performing anastomoses during gastrointestinal surgery. It notes important factors to consider like blood supply, tension, and diameter. For colorectal and small bowel anastomoses, it recommends using slowly absorbable monofilament sutures with a 5mm bite from the margin. A single-layer inverting anastomosis is preferred for colorectal procedures as it is less time-consuming and reduces inflammation. Advantages of the single-row suture technique include faster performance and less trauma. End-to-end anastomoses should include the muscular mucosa. Side-to-side anastomoses employ a four-layer technique with separate sutures for the posterior

1. Anastomotic techniques
Dr. Aditya Yadav
MS (Gen Surgery)

2. Factors to note:
• Blood Supply
• Transillumination to identify mesenteric blood vessels
• Isolation of vessels by dividing surrounding fat
• Division between clamps
• Ligation with suitable sutures to prevent knot slippage
• On-needle transfixation of large vascular pedicles with nonabsorbable sutures is a safer method.
• Tension
• Anastomotic diameter
• Mesentery
• Drains
• Handsewing/ staplers

3. Basics in Colo-rectal and small bowel anastomosis:
• Suture material: slowly absorbable non absorbable monofilament .
• Size of suture bite: 5 mm from margin, 3-5 in next suturing.
• Inverting vs everting : inverting
• Single vs double layered: in colorectal anastomosis, single layered -
less time consuming, less costly, lesser post anastomotic inflammation.
• Interrupted vs continuous:
• Hand sewn vs Staplers- staplers are good for less experienced surgeon
otherwise no added benefit in term of leak.

4. Advantages of the single - row suture:
1) performance speed;
2) lesser traumatization ;
3) lesser amount of foreign tissue ;
4) better intestinal wall layers cohesion;
5) smaller tissue adhesion area ;
6) lesser extent of lumen distortion ;
7) lesser extent of blood and lymph circulation compromise ;
8) faster tissue regeneration ;
9) faster and better scar formation ;
10) lesser extent of tissue infiltration ;
11) lesser chance of microabscess formation ;
12) faster immune suture rejection
13) more adequate anastomosis ;
14) lesser suture failure rate.

5. End to end Anastomosis
• Single layered interrupted extra mucosal ,
• Mucosa does nothing but heamostasis only
• Mucosa is already apronxipamted with good extramucosal
approximation and starts healing within 24 hours
• Always include muscular mucosa
• Railroading and parachutin in restricted access

13. End to side
• An end-to-side sutured anastomosis is merely an adaptation of the
end-to-end technique.
• the length of the incision should be such that there are two equal
‘lumens’ for the anastomosis.
• The suture technique used is similar to t an end-to-end
anastomosis.

14. Side to Side
Four layer technique
• Posterior seromuscular suture. This is a continuous absorbable suture that does not include the
mucosa and that unites the adjacent surfaces of gut
• Posterior all-layer suture. This suture begins at one extremity of the incisions and unites the
posterior cut edges, travers- ing all coats of the gut.
• Anterior all-layer suture. This suture begins as a continuation of the posterior layer, the needle
passing from one lumen to the other as before, except that the wall of each gut edge must be
traversed separately
• Anterior seromuscular suture. This suture begins as a continuation of the posterior seromuscular
suture and on completion is tied to the end that was held in forceps at the start of the procedure