The variation in technique of resection

Objective 4: Variation of resection

For a successful anastomosis all resections need

• Good mobilization and exteriorisation of the bowel and ileum
• To be tension free
• A good blood supply

There is however considerable variation in how the resection is carried out and the anatomical arrangement of the anastomosis with no randomised evidence that any configuration is better or worse.

In the Delphi consensus process agreement was reached around the following broad principles for optimisation of both a stapled or handsewn ileocolic anastomosis:

1. Good perfusion of both limbs of the anastomosis:

• Through adequate preparation of bowel stumps and mesentery
• Avoid unnecessary dissection of mesentery that risks compromise to the blood supply

2. Avoiding tension at the anastomosis

• Through appropriate mobilisation of the hepatic flexure, Toldt’s fascia, mesentery and greater omentum
• By freeing any adhesions, where necessary

3. Meticulous technique

• Adequate choice and use of a stapler device, including standardised stapler compression and firing
• Adequate choice and technique of suture placement
• Use of a harmonised technique for ileocolic anastomosis

4. Use of the ESCP Safe-anastomosis checklist 

• To support intra-operative multidisciplinary decision making
• See Module 2: ESCP Safe-anastomosis checklist