Harmonising handsewn anastomosis technique
Objective 3. Explore the evidence for a harmonised technique for handsewn anastomosis
In ESCP 2015 data, a side-to-side configuration was the most common choice for handsewn anastomosis. However several configurations exist. In this section we will give an example of several configurations of handsewn anastomosis. No prospective randomised trials have shown benefit of one anastomotic configuration over another. We’ve read already in ‘Module 4: Stapled anastomosis’ that no differences in clinical outcomes have been antiperistaltic and isoperistaltic anastomoses.
In the Delphi consensus process, no single preference for configuration of a handsewn anastomosis was reached.
The video below demonstrates one technique for side-to-side antiperistaltic handsewn anastomosis
Key learning points from the ESCP Delphi Consensus for handsewn ileocolic anastomosis are shared in this section.
1. Regarding placement of ‘stay sutures’ before beginning the anastomosis
Surgeons agreed that these were useful, and ensured luminal alignment
2. Regarding the enterotomies and closure of the bowel stumps
- Surgeons agreed that the enterotomy should be made on the anti-mesenteric border
- Surgeons agreed that the enterotomy should be at least the transverse diameter of the patient’s small bowel.
- Surgeons thought that closure of the common enterotomy either with sutures or a linear cutting stapler were both acceptable.
- Surgeons agreed that routine oversewing of the staple line in the absence of concerns about bleeding or staple line integrity was not required, but was acceptable if desired.