Anastomotic technique—Does it make a difference?

Abstract

The morbidity and mortality associated with anastomotic leak (AL) can be severe. Surgeons have long sought to refine the technical aspects of constructing anastomoses with the goal of lowering incidence of AL. Anastomotic technique is aimed at creating a well-perfused, tension-free anastomosis. Anastomoses can performed using hand-sewn technique or with surgical staplers. There are many variations in the hand-sewn technique, such as the type of suture material used, the number of layers and whether the bowel is inverted or everted. The introduction of surgical staplers has altered the technical ease of constructing anastomoses, and this has contributed to their widespread clinical use. However, stapled anastomoses have not proven to be superior to hand-sewn anastomoses in the development of AL. Many other factors have been studied, such as anastomotic configuration (end-to-end, side-to-end, straight coloanal, colonic J-pouch, or transverse coloplasty), high versus low ligation of the inferior mesenteric artery ligation, omentoplasty, and prophylactic drain placement, but none have consistently been shown to prevent the development of AL.