Checking the handsewn anastomosis
Objective 4. Learn how to check the handsewn anastomosis
The principles of checking for a SAFE anastomosis also apply here to the handsewn anastomosis, with some small variations only. The air insufflation test (underwater) is rarely used in right sided 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.
In the handsewn anastomosis, an additional test is recommended upon external inspection
The forecepts test
In order to complete a foreceps test, gently and circumferential explore the suture lines looking for any gaps between sutures or bleeding points. You should add additional sutures if any gaps are detected using the foreceps.
Inspect the suture line under direct vision. Control any bleeding using compression and a single suture where necessary, so the suture line is not disrupted.
The video below shows surgeons discussing how they test their handsewn anastomoses, and an example of a foreceps test.
Finally, a video of surgeons discussing whether or not they close the mesenteric window in right colectomy: