Alternative configurations
Objective 3. Explore the evidence for a harmonised technique for handsewn anastomosis
Several alternative configurations for handsewn ileocolic anastomosis exist.
In this section we will review two other possible configurations for handsewn anastomoses.
End-to-end anastomosis
The video below demonstrates one technique for end-to-end handsewn anastomosis. A Cheatle incision on the anti-mesenteric border of the ileum can be used to address a luminal size discrepancy by creating a larger opening.
End-to-side anastomosis
The video below demonstrates one technique for end-to-side handsewn anastomosis. Note that in the 2015 ESCP audit of right sided anastomosis, this configuration was used in less than 5% of cases.
As with stapled anastomoses, there may be a benefit in reducing variation in practice for handsewn ileocolic anastomoses.
Related paper: Changes in Clinical Practice Reduce the Rate of Anastomotic Leakage After Colorectal Resections
ESCP Safe-anastomosis programme recommends that you use the evidence presented here to discuss practice within your unit and see where you might harmonise techniques across surgeons.
See the video below for a discussion between surgeons about use similar configurations for both stapled and handsewn anastomoses: