search
An anastomosis is defined as a surgical connection between adjacent channels.
Typically, for right hemicolectomy, an anastomosis is created between the transverse colon and the terminal ileum after exteriorization and subsequent division of the bowel. This requires traction and manipulation of the segment involved which ultimately increases the impact of the surgical insult.
Laparoscopic surgery has been the epitome of MIS over the last 4 decades, however its basic principles are usually breached during the reconstructive phase of right hemicolectomies.
An intracorporeal anastomosis in this type of cases has many potential advantages that include:
Lesser surgical insult
Decreased length of stay
Fewer hernias
Potential shorter incision
Decreased risk of bleeding and serosa tears
There is evidence supporting this: the existing RCT demonstrated faster recovery with no effect on LOSS. However, many cultural and personal factor in surgeons and patients have an impact.
Technical aspects include:
Positioning: Supine in a secured fashion (able to tolerate Trendelenburg and lateral tilt positions.
Surgical ports are placed as depicted.
Regular laparoscopic equipment is used, including linear endo GI staplers and a barbed 3-0 suture.
The video deshowmonstrates the steps.
Mesenteric division x 2 Colon and small bowel (Harmonic ® scalpel)
Colonic transection. (Transverse)
Small bowel transection (Ileum)
Specimen to be shelved on the liver
Enterotomies (“hot Maryland” Using cut at 30-40)
Bowel alignment, 3-0 Vicryl stitch
Isoperistaltic side to side functional anastomosis.
Closure of common enterotomy with barbed 3-0 suture (V-Loc ®)
Surgeon MUST start closing from the bottom up ( otherwise will leave
An undetectable open defect in the lower pole.
Ensuring full thickness through and through stitches 3-5 mm apart.
Surgeon to present tissue with suture traction.
Synching stitch with mounted needle.
Assistant needs to hold common enterotomy up.
Secure specimen
Create a Pfannenstiel incision (Stay AWAY from midline incisions)