Bowel Anastomosis in Acute Care Surgery
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Purpose of Review
Acute care surgery encompasses the disciplines of trauma, emergency general surgery, and surgical critical care. Inherent in the disease processes of trauma and emergency general surgery is the potential for profound physiologic and anatomic derangements that make the decision to create an intestinal anastomosis, as well as the technique used, a vital step in having a successful outcome for the patient.
The trauma literature is rife with conflicting data regarding ideal techniques for anastomosis creation. Two series by Brundage and colleagues suggest that handsewn techniques are superior, which was then contradicted by Witzke et al. Vasopressor usage and blood transfusion appear to put the patient at higher risk for anastomotic failure, as does the utilization of damage control techniques. The emergency general surgery literature is similarly contradicting, with one large retrospective study suggesting handsewn techniques to be superior and a subsequent prospective multicenter study suggesting no difference. Damage control patients do appear to have higher anastomotic failure rates, with the noted absence of good data regarding colorectal resections and ideal management strategies.
With the conflicting messages throughout the literature, the acute care surgeon must utilize sound surgical principles and techniques when deciding to perform an anastomosis and choosing a technique to utilize.
KeywordsBowel anastomosis Bowel resection Handsewn surgical techniques Anastomotic failure Stoma
Compliance with Ethics Guidelines
Conflict of interest
The authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 17.•• Farrah JP, Lauer CW, Bray MS, et al. Stapled versus hand-sewn anastomoses in emergency general surgery: a retrospective review of outcomes in a unique patient population. J Trauma Acute Care Surg. 2013;74(5):1187–94. doi: 10.1097/TA.0b013e31828cc9c4. This study is a single-center effort specifically examining anastomotic techniques in emergency general surgery patients.CrossRefPubMedGoogle Scholar
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