Bowel Anastomosis

Dr Dawit
 Bowel Anastomosis
• Is a surgical procedure performed to establish
communication between two formerly distant
portions of the intestine.
• This procedure restores intestinal continuity
after removal of a pathologic condition
affecting the bowel.
Indications
 broadly divided into two categories:
• restoration of bowel continuity following
resection of diseased bowel and
• bypass of unresectable diseased bowel.
Contraindications:
 include conditions in which there is high risk of
anastomotic leak, such as the following:
• Severe sepsis
• Poor nutritional status (eg, severe hypoalbuminemia)
• Disseminated malignancy (multiple peritoneal and
serosal deposits, ascites)
• Viability of bowel in doubt
• Fecal contamination or frank peritonitis
• Unhealthy bowel condition
• After mobilization of the bowel, the next step is
division of the mesentery.
Principles to be followed in division of the
mesentery include the following:
– Transillumination to identify mesenteric blood vessels
– Isolation of vessels by dividing surrounding fat
– Division between clamps
– Ligation with suitable sutures to prevent knot slippage
• A staged procedure may be preferred for
restoration of bowel continuity if the general
condition of the patient is not good enough to
avoid the complications associated with
anastomotic leakage.
 Tenets of good intestinal anastomosis:
• Adequate exposure and access
• gentle handling of the bowel
• adequate hemostasis
• approximation of well-vascularized bowel
• absence of tension at anastomosis
• good surgical technique, and
• avoidance of fecal contamination
Complications
• Important complications following intestinal
anastomosis include the following:

– Anastomotic leakage
– Bleeding
– Wound infection
– Anastomotic stricture
– Prolonged functional ileus, especially in children
end