Current Surgery Reports

, 5:29 | Cite as

Bowel Anastomosis in Acute Care Surgery

  • Brandon Robert BrunsEmail author
Trauma Surgery (J. Diaz, Section Editor)
Part of the following topical collections:
  1. Trauma Surgery


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.

Recent Findings

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.


Bowel 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

  1. 1.
    Committee to Develop the Reorganized Specialty of Trauma, Surgical Critical Care, and Emergency Surgery. Acute care surgery: trauma, critical care, and emergency surgery. J Trauma. 2005;58(3):614–6.CrossRefGoogle Scholar
  2. 2.
    Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011;. doi: 10.1002/14651858.CD004320.pub3.PubMedGoogle Scholar
  3. 3.
    Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2012;. doi: 10.1002/14651858.CD003144.pub2.PubMedGoogle Scholar
  4. 4.
    Morse BC, Simpson JP, Jones YR, Johnson BL, Knott BM, Kotrady JA. Determination of independent predictive factors for anastomotic leak: analysis of 682 intestinal anastomoses. Am J Surg. 2013;206(6):950–5. doi: 10.1016/j.amjsurg.2013.07.017 discussion 955–6.CrossRefPubMedGoogle Scholar
  5. 5.
    European Society of Coloproctology collaborating group. The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: An international snapshot audit. Colorectal Dis. 2017;. doi: 10.1111/codi.13646.Google Scholar
  6. 6.
    Brundage SI, Jurkovich GJ, Grossman DC, Tong WC, Mack CD, Maier RV. Stapled versus sutured gastrointestinal anastomoses in the trauma patient. J Trauma. 1999;47(3):500–7 discussion 507–8.CrossRefPubMedGoogle Scholar
  7. 7.
    • Brundage SI, Jurkovich GJ, Hoyt DB, et al. Stapled versus sutured gastrointestinal anastomoses in the trauma patient: a multicenter trial. J Trauma. 2001;51(6):1054–61. This study is a large multicenter study specifically examining trauma patients and anastomotic techniques.PubMedGoogle Scholar
  8. 8.
    Witzke JD, Kraatz JJ, Morken JM, et al. Stapled versus hand sewn anastomoses in patients with small bowel injury: a changing perspective. J Trauma. 2000;49(4):660–5 discussion 665–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Demetriades D, Murray JA, Chan LS, et al. Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study. J Trauma. 2002;52(1):117–21.PubMedGoogle Scholar
  10. 10.
    Demetriades D, Murray JA, Chan L, et al. Penetrating colon injuries requiring resection: Diversion or primary anastomosis? an AAST prospective multicenter study. J Trauma. 2001;50(5):765–75.CrossRefPubMedGoogle Scholar
  11. 11.
    Fischer PE, Nunn AM, Wormer BA, et al. Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries. Am J Surg. 2013;206(6):900–3. doi: 10.1016/j.amjsurg.2013.07.034.CrossRefPubMedGoogle Scholar
  12. 12.
    Rotondo MF, Schwab CW, McGonigal MD, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35(3):375–82 discussion 382–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Harvin JA, Maxim T, Inaba K, et al. Mortality following emergent trauma laparotomy: A multicenter, retrospective study: mortality after emergent trauma laparotomy. J Trauma Acute Care Surg. 2017;. doi: 10.1097/TA.0000000000001619.Google Scholar
  14. 14.
    Miller PR, Chang MC, Hoth JJ, Holmes JH, Meredith JW. Colonic resection in the setting of damage control laparotomy: is delayed anastomosis safe? Am Surg. 2007;73(6):606–9 discussion 609–10.PubMedGoogle Scholar
  15. 15.
    Ordonez CA, Pino LF, Badiel M, et al. Safety of performing a delayed anastomosis during damage control laparotomy in patients with destructive colon injuries. J Trauma. 2011;71(6):1512–7. doi: 10.1097/TA.0b013e31823d0691 discussion 1517–8.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Ott MM, Norris PR, Diaz JJ, et al. Colon anastomosis after damage control laparotomy: recommendations from 174 trauma colectomies. J Trauma. 2011;70(3):595–602. doi: 10.1097/TA.0b013e31820b5dbf.CrossRefPubMedGoogle Scholar
  17. 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
  18. 18.
    • Bruns BR, Morris DS, Zielinski M, et al. Stapled versus hand-sewn: a prospective emergency surgery study. an american association for the surgery of trauma multi-institutional study. J Trauma Acute Care Surg. 2017;82(3):435–43. doi: 10.1097/TA.0000000000001354. This paper represents this largest effort to examine stapled versus handsewn techniques in emergency general surgery patients.CrossRefPubMedGoogle Scholar
  19. 19.
    Bruns BR, Ahmad SA, O’Meara L, et al. Nontrauma open abdomens: a prospective observational study. J Trauma Acute Care Surg. 2016;80(4):631–6. doi: 10.1097/TA.0000000000000958.CrossRefPubMedGoogle Scholar
  20. 20.
    O’Meara L, Ahmad SB, Glaser J, Diaz JJ, Bruns BR. Outcomes of primary fascial closure after open abdomen for nontrauma emergency general surgery patients. Am J Surg. 2015;210(6):1126–30. doi: 10.1016/j.amjsurg.2015.06.030 discussion 1130–1.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.R Adams Cowley Shock Trauma CenterUniversity of Maryland Medical CenterBaltimoreUSA

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