Skip to main content
SpringerLink
Log in
Book cover

Fundamentals of General Surgery pp 227–237Cite as

Fundamentals of Gastrointestinal Anastomoses

  • Chapter
  • First Online:

  • 3111 Accesses

Abstract

The creation of a gastrointestinal anastomosis is a fundamental skill essential to general surgery. This chapter will detail the history of gastrointestinal anastomoses, will provide general principles to be used when joining segments in the gastrointestinal tract, and will review key technical considerations that the general surgeon should keep in mind when constructing some of the most common intestinal anastomoses. A brief review of current controversial areas is also provided.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Suggested Readings

  • Shackelford RT, Zuidema GD, Bickham WS. Surgery of the alimentary tract. 2d ed. Philadelphia: Saunders; 1978.

    Google Scholar 

  • Ravitch MM, Rivarola A. Enteroanastomosis with an automatic instrument. Surgery. 1966;59(2):270–7.

    PubMed  CAS  Google Scholar 

  • Choy PY, Bissett IP, Docherty JG, et al. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011(9):CD004320.

    Google Scholar 

  • Thornton FJ, Barbul A. Healing in the gastrointestinal tract. Surg Clin North Am. 1997;77(3):549–73.

    Article  PubMed  CAS  Google Scholar 

  • Stenberg E, Szabo E, Agren G, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicenter, randomized, parallel, open-label trial. Lancet. 2016;387(10026):1397–404.

    Article  PubMed  Google Scholar 

References

  1. Ravitch MM, Canalis F, Weinshelbaum A, et al. Studies in intestinal healing. 3. Observations on everting intestinal anastomoses. Ann Surg. 1967;166(4):670–80.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Shackelford RT, Zuidema GD, Bickham WS. Surgery of the alimentary tract. 2d ed. Philadelphia: Saunders; 1978.

    Google Scholar 

  3. Halsted WS. Practical circular suture of the intestines; an experimental study. Am J Med Sci. 1887;94:436–61.

    Article  Google Scholar 

  4. Getzen LC, Roe RD, Holloway CK. Comparative study of intestinal anastomotic healing in inverted and everted closures. Surg Gynecol Obstet. 1966;123(6):1219–27.

    PubMed  CAS  Google Scholar 

  5. Goligher JC. Visceral and parietal suture in abdominal surgery. Am J Surg. 1976;131(2):130–40.

    Article  PubMed  CAS  Google Scholar 

  6. Trueblood HW, Nelsen TS, Kohatsu S. Wound healing in the colon: comparison of inverted and everted closures. Surgery. 1969;65:919.

    PubMed  CAS  Google Scholar 

  7. Gill W, Fraser SJ, Carter DC. Everted intestinal anastomosis. Surg Gynecol Obstet. 1969;128:1297.

    PubMed  CAS  Google Scholar 

  8. Ravitch MM, Rivarola A. Enteroanastomosis with an automatic instrument. Surgery. 1966;59(2):270–7.

    PubMed  CAS  Google Scholar 

  9. Goulder F. Bowel anastomoses: the theory, the practice and the evidence base. World J Gastrointest Surg. 2012;4(9):208–13.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kracht M, Hay JM, Fagniez PL, et al. Ileocolonic anastomosis after right hemicolectomy for carcinoma: stapled or hand-sewn? A prospective, multicenter, randomized trial. Int J Color Dis. 1993;8(1):29–33.

    Article  CAS  Google Scholar 

  11. Choy PY, Bissett IP, Docherty JG, et al. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011(9):CD004320.

    Google Scholar 

  12. Brundage SI, Jurkovich GJ, Hoyt DB, et al. Stapled versus sutured gastrointestinal anastomoses in the trauma patient: a multicenter trial. J Trauma. 2001;51:1054–61.

    Article  PubMed  CAS  Google Scholar 

  13. Demetriades D, Murray JA, Chan LS, et al. Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study. J Trauma. 2002;52:117–21.

    PubMed  Google Scholar 

  14. Lustosa SA, Matos D, Atallah AN, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2001(3):CD003144.

    Google Scholar 

  15. Thornton FJ, Barbul A. Healing in the gastrointestinal tract. Surg Clin North Am. 1997;77(3):549–73.

    Article  PubMed  CAS  Google Scholar 

  16. Mall F. A study of intestinal contraction. Healing of intestinal sutures. Reversal of the intestine. Boston: U Holzer; 1887. p. 77.

    Google Scholar 

  17. Jibom H, Ahonen J, Zederfeldt B. Healing of experimental colonic anastomoses. III. Collagen metabolism in the colon after left colon resection. Am J Surg. 1980;139:398.

    Article  Google Scholar 

  18. Stromberg BV, Klein L. Collagen formation during the healing of colonic anastomoses. Dis Colon Rectum. 1982;25:301.

    Article  PubMed  CAS  Google Scholar 

  19. Mori N, Doi Y, Hara K, et al. Role of multipotent fibroblasts in the healing colonic mucosa of rabbits. Ultrastructural and immunocytochemical study. Histol Histopathol. 1992;7:583.

    PubMed  CAS  Google Scholar 

  20. diZerega GS. The peritoneum and its response to surgical injury. Prog Clin Biol Res. 1990;358:1.

    PubMed  CAS  Google Scholar 

  21. LaCalle JP, Sole JM, Pey GC, et al. Rotated intestinal anastomoses. Surg Gynecol Obstet. 1982;154:662.

    PubMed  CAS  Google Scholar 

  22. Goligher JC, Graham NG, De Dombal ET. Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg. 1970;57:109.

    Article  PubMed  CAS  Google Scholar 

  23. Halsted WS. Circular suture of the intestine: an experimental study. Am J Med Sci. 1887;94:436.

    Article  Google Scholar 

  24. Graham MF, Diegelmann RF, Elson CO, et al. Collagen content and types in the intestinal strictures of Crohn’s disease. Gastroenterology. 1988;94:257.

    Article  PubMed  CAS  Google Scholar 

  25. Graham MF, Blomquist P, Zederfeldt B. The alimentary canal. In: Wound healing: biochemical and clinical aspects. Philadelphia: WB Saunders; 1992. p. 433.

    Google Scholar 

  26. Ellison G. Wound healing in the gastrointestinal tract. Semin Vet Med Surg. 1989;4:287.

    CAS  Google Scholar 

  27. Hunt TK, Zederfeldt B, Goldstick TK. Oxygen and healing [review]. Am J Surg. 1969;118:521.

    Article  PubMed  CAS  Google Scholar 

  28. Wise L, McAlister W, Stein T, et al. Studies on the healing of anastomoses of small and large intestines. Surg Gynecol Obstet. 1975;141:190.

    PubMed  CAS  Google Scholar 

  29. Carrico TJ, Mehrhof AJ, Cohen IK. Biology of wound healing [review]. Surg Clin North Am. 1984;64:721.

    Article  PubMed  CAS  Google Scholar 

  30. Udenfriend S. Formation of hydroxyproline in collagen [review]. Science. 1966;152:1335.

    Article  PubMed  CAS  Google Scholar 

  31. Chung R. Blood flow in colonic anastomoses. Effect of stapling and suturing. Ann Surg. 1987;206:335.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Schrock T, Cerra F, Hawley PR, et al. Wounds and wound healing (clinical conference). Dis Colon Rectum. 1982;25:1.

    Article  PubMed  CAS  Google Scholar 

  33. Hogstrom H, Haglund U, Zederfeldt B. Tension leads to increased neutrophil accumulation and decreased laparotomy wound strength. Surgery. 1990;107:215.

    CAS  PubMed  Google Scholar 

  34. Shikata J, Shida T. Effects of tension on local blood flow in experimental intestinal anastomoses. J Surg Res. 1986;40:105.

    Article  CAS  PubMed  Google Scholar 

  35. Yeo CJ. Shackelford’s surgery of the alimentary tract. 7th ed. Philadelphia: Elsevier/Saunders; 2013.

    Google Scholar 

  36. Chekan E, Whelan RL. Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. Med Devices. 2014;7:305–18.

    Article  Google Scholar 

  37. Brolen RE, Kella VN. Impact of complete mesenteric closure on small bowel obstruction and internal mesenteric hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(6):850–4.

    Article  Google Scholar 

  38. Stenberg E, Szabo E, Agren G, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicenter, randomized, parallel, open-label trial. Lancet. 2016;387(10026):1397–404.

    Article  PubMed  Google Scholar 

  39. Aghajani E, Nergaard BJ, Leifson BG, et al. The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc. 2017;31:3743–8. https://doi.org/10.1007/s00464-017-5415-.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sim WH, Wong KY. Mesenteric defect after laparoscopic left hemicolectomy: to close or not to close? Int J Color Dis. 2016;31(7):1389–91.

    Article  Google Scholar 

  41. Cabot JC, Lee SA, Yoo J, et al. Long-term consequences of not closing the mesenteric defect after laparoscopic right colectomy. Dis Colon Rectum. 2010;53(3):289–92.

    Article  PubMed  Google Scholar 

  42. Wade A, Dugan A, Plymale MA, et al. Hiatal hernia cruroplasty with a running barbed suture compared to interrupted suture repair. Am Surg. 2016;82(9):271–4.

    Google Scholar 

  43. Takayama S, Nakai N, Shiozaki M, et al. Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair. World J Gastrointest Surg. 2012;4(7):177–9.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bautista T, Shabbir A, Rao J, et al. Enterotomy closure using knotless and barbed suture in laparoscopic upper gastrointestinal surgeries. Surg Endosc. 2016;30(4):1699–703.

    Article  PubMed  Google Scholar 

  45. Blasi VD, Facy O, Goergen M, et al. Barbed versus usual suture for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial. Obes Surg. 2013;23(1):60–3.

    Article  PubMed  Google Scholar 

  46. Marco Milone M, Di Minno MN, Galloro G, et al. Safety and efficacy of barbed suture for gastrointestinal suture: a prospective and randomized study on obese patients undergoing gastric bypass. J Laparoendosc Adv Surg Tech A. 2013;23(9):756–9.

    Article  PubMed  Google Scholar 

  47. Boni L, Fingerhut A, Marzorati A, et al. Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc. 2017;31(4):1936–840.

    Article  Google Scholar 

  48. Urbanavicius L, Pattyn P, de Putte DV, et al. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg. 2011;3(5):59–69.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Jafari MD, Wexner SD, Martz JE, et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg. 2015;220(1):82–92.

    Article  PubMed  Google Scholar 

  50. Holm C, Tegeler J, Mayr M, et al. Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience. Microsurgery. 2002;22(7):278–87.

    Article  PubMed  CAS  Google Scholar 

  51. Hutteman M, Van Der Vorst JR, Mieog JSD, et al. Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy. Eur Surg Res. 2011;47(2):90–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. Rodriguez-Hernandez A, Lawton MT. Flash fluorescence with indocyanine green videoangiography to identify the recipient artery for bypass with distal middle cerebral artery aneurysms: operative technique. Neurosurgery. 2012;70(2):209–20.

    PubMed  Google Scholar 

  53. Shimada Y, Okumura T, Nagata T, et al. Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy. Esophagus. 2011;8(4):259–66.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Still J, Law E, Dawson J, et al. Evaluation of the circulation of reconstructive flaps using laser induced fluorescence of indocyanine green. Ann Plast Surg. 1999;42(3):266–74.

    Article  PubMed  CAS  Google Scholar 

  55. Waseda K, Ako J, Hasegawa T, et al. Intraoperative fluorescence imaging system for on-site assessment of off-pump coronary artery bypass graft. JACC Cardiovasc Imaging. 2009;2(5):604–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Talar Tatarian, Andrew M. Brown, Michael J. Pucci & Francesco Palazzo

Authors
  1. Talar Tatarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael J. Pucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Palazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Palazzo .

Editor information

Editors and Affiliations

  1. Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Francesco Palazzo

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tatarian, T., Brown, A.M., Pucci, M.J., Palazzo, F. (2018). Fundamentals of Gastrointestinal Anastomoses. In: Palazzo, F. (eds) Fundamentals of General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-75656-1_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-75656-1_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-75655-4

  • Online ISBN: 978-3-319-75656-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation