Checking the stapled anastomosis
Objective 4: Learn how to check the stapled anastomosis, ensuring it is SAFE
The benefit of anastomotic testing has been well established in left colonic and rectal surgery and forms part of international best practice guidelines
Related paper: Prevention, diagnosis and management of colorectal anastomotic leakage
Leak testing for right colon is more difficult and not currently routinely performed.
However there are simple set of checks that can be performed in every right sided ileocolic resection to ensure you have formed a SAFE anastomosis
How to test for a SAFE handsewn anastomosis:
Are both limbs pink and well perfused? (or are you satisfied with ICG test if you routinely use this in your centre)
Is the luminal diameter of sufficient size for small bowel contents to pass through freely?
Are the limbs correctly orientated, and not under torsion?
Does your ‘Squeeze test’ (trap air and/or small bowel contents and ‘milk’ this across the anastomosis) demonstrate any air bubbles? This does not need to be performed underwater. If a ‘squeeze test’ is positive, the surgeon then has the option to reinforce or re-form the anastomosis.
Inspect the staple line under direct vision. Control any bleeding along the everted staple line using single sutures, but avoid using diathermy. You should avoid formation of haematoma at the staple line, using compression to minimise this where necessary.
Supply: ensuring adequate perfusion
The video below shows a discussion between surgeons about important considerations in preventing ischaemia at the anastomosis:
Fidelity: the ‘Squeeze test’
The video below is a discussion between surgeons about how they test the anastomosis using a ‘squeeze test’
Everted staple line: inspecting for bleeding
The video below shows surgeons discussing how they inspect the staple line for bleeding: