Knowledge of the basic principles of bowel resection, anastomosis, and the stoma formation, will allow the gynecologist to competently manage many scenarios in which malignancies involve the bowel and require resection for restoration of bowel continuity. In patients with ramified pelvic tumours, a colorectal surgeon may be required as portion of the multidisciplinary approach to ensure complete removal of the cancer (Alves et al., 2004). The type of the intestinal anastomosis one performs depends on personnel preference but irrespective of the technique availed, principles that ensure a successful outcome include: good vascular supply to segments being specifically approximated, no distal obstruction, and a tension free repair. There are certain bowel disorders like bloating, colic pain etc (Sreeremya, 2018).

1. Anastomosis
BY Dr. S.SREEREMYA
FACULTY OF BIOLOGY

2. •
• Knowledge of the basic principles of bowel resection, anastomosis,
and the stoma formation, will allow the gynecologist to
competently manage many scenarios in which malignancies involve
the bowel and require resection for restoration of bowel continuity.
In patients with ramified pelvic tumours, a colorectal surgeon may
be required as portion of the multidisciplinary approach to ensure
complete removal of the cancer (Alves et al., 2004).
• The type of the intestinal anastomosis one performs depends on
personnel preference but irrespective of the technique availed,
principles that ensure a successful outcome include: good vascular
supply to segments being specifically approximated, no distal
obstruction, and a tension free repair. There are certain bowel
disorders like bloating, colic pain etc (Sreeremya, 2018).

3. • In common, if the segments being opposed can overlap
then the suture line will be quiet tension free. Adequate
mobilization is particularly important for anastomosis and
the stoma formation involving the large bowel .In recent
years, there has been a large shift towards the use of the
intestinal stapling devices. They offer potential reduction
inoperative time and are allied with a faster learning curve
than for hand-sewn techniques, making them popular with
the trainee. The circular stapling devices are specifically
useful when performing a low anterior resection. However,
one believe that one should be familiar with both
techniques with intra operative circumstances and available
resources dictating the clinical decisions (Debinsky et
al.,1996).

4. • When performing the bowel surgery one should be able to competently
form an ileostomy or colostomy (Church et al., 2000). It is preferable to
mark stoma site preoperatively, away from the bony prominences, skin
creases, and within the surface marking of the rectus abdominus (Hassan
et al., 2005). A defunctioning loop ileostomy will garner protection of a
distal anastomosis or faecal diversion in patients with an allied fistula and
can be easily reversed once the underlying the pathology has resolved
(Bülow et al., 2008). Iatrogenic large bowel injuries, particularly those
involving the left colon and allied with faecal contamination or a delay in
diagnosis, may necessitate a colostomy (Bertario et al., 2000). PRINCIPLES
OF MANAGEMENT
• In patients with the advanced ovarian cancer one should aim for
maximum tumour volume removal. In many cases, the gastrointestinal
tract is mainly involved and primary cytoreductive surgery may require the
concomitant recto sigmoid colectomy or small bowel resection (Nylund et
al., 2001). The decision to resect the diseased or injured segment of bowel
is usually straight forward.

5. • One generally use a double-layer technique for intestinal
anastomosis but appreciate that the single-layer
continuous anastomostic technique has also been show to
be safe and may be favoured by many of the
surgeons(Scott-Conner,2006) . Where malignancies involve
the small bowel necessitating resection, the bowel ends
can be quiet safely anatomosed and in the majority of
cases there are no indications for a defunctioning stoma.
Because ovarian metastasis to the intestinal tract are
frequently allied with mesenteric lymph node involvement,
we would advise resection of a wedge of mesentery similar
to that required for the primary bowel carcinoma (Milsom
et al., 1997).

6. • In many scenarios, the pelvic tumour is large involving the segment
of colon or rectum requiring resection. In the elective setting,
preoperative imaging should mainly identify involved bowel,
allowing adequate bowel preparation, so that intraopertatively one
can safely perform a primary anastomosis and avoid the two-stage
procedure, which would be required for the reversal of a stoma
(Seshadri et al., 2001). If the bowel preparation is inadequate, if it is
a low rectal anastomosis, if there is an extensive post radiotherapy
oedema, or considerable peritoneal contamination at times of
resection, it may be safer to protect the anastomosis with the
proximal defunctioning stoma (Salum et al., 2004). In many cases,
the clinical decision is dictated by ones’ intraoperative findings.

8. • ANASTOMOSIS AND CROHN’S
• IRA may be considered in carefully selected patients
with the Crohn’s colitis as an alternative to
proctocolectomy and stoma. The issues regarding the
state of the rectal reservoir and the sphincter
mechanism, as outline above for the patients with UC,
are equally relevant. The eventual fate of the rectum
after IRA in Crohn’s disease has been the subject of
varying retrospective studies. Researchers studied 119
patients with Crohn’s disease who were treated with
total colectomy and IRA.

9. •
• Journal of Pharmaceutical Management and
Medical Laboratory Technology, Anastomosis,
Dr.S.Sreeremya , 2019.Vol 1(1):1-11