SURGICAL TECHNIQUES
A TECHNIQUE OF ANASTOMOSING BOWEL ENDS WITH DISCREPANCY IN SIZE M. GOLD BERG^ Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota.
SANTHAT NIVATVONGS' AND STANLEY
There have been only a few methods devised to solve the problem of discrepancy In size of the bowel ends for anastomosis. We descrbe another method to overcome this problem b y using a one-layer open technique. For the posterior wall the anastomosis consists of a horizontal mattress suture on the larger end and a vertical mattress suture on the smaller end. For the anterior wall the Gambee suture is used.
QUITE often a surgeon encounters a situation where the two ends of bowel for the anastomosis are significantly different i n size. For years there have been only a few methods devised to solve this problem, such as the use of the Cheatle incision Barnes et alii (1975), oblique transection of the smaller end of the bowel, and the side-to-end anastomosis (Baker 1950). We have adopted a secure and simple technique to overcome this problem. TECHNIQUE This is an open anastomosis with no clamps applied on the bowel. We use one-layer full thickness, mucosal inversion anastomosis, with 4/0 polypropylene.
The posterior wa//.- A mattress suture is used, with the knots tied inside the lumen. On the larger diameter side a horizontal full thickness mattress suture is applied (Figure 1). On thesmallerdiameter side a vertical mattres is employed, with full thickness o n first bite and only submucosa and mucosa in the same vertical plane on the subsequent bite (Figure 1A). When all the sutures are tied, the larger lumen side will slightly decrease
in size, but the smaller lumen side will stretch to almost equal size with the opposite end (Figure 2). The anterior wa//.- An interrupted full thickness suture with only mucosal inversion as described by Gambee (1951) is used (Figure 3.3A). If significant difference in the size of the lumen still exists, an interrupted Connell suture is used on the larger lumen side (Figure 4 ) . During the past two years we have used this technique with satisfaction whenever needed in i l e o c o l o s t o m y , ileorectal anastomosis, and colorectal anastomosis.
REFERENCES BAKER, J. W. (1950), Arch. SUfg., 61: 143 BARNES, J. P.. GREER, C. R . andSASS0. R . D. (1975),Aflfl. Surg., 182: 650. GAMEEE,L. P. (1951). West. J. Surg., 59: 1.
'Assistant Professor of Surgery, Division of Colon and Rectal Surgery 'Clinical Professor of Surgery and Director Division of Colon and Rectal Surgery Reprints Santhat Nivatvongs, M D , Box 450, University Hospitals. Minneapolis. Minnesota 55455, U S A
AUST.N.Z. J. SURG.VOL. 49
- No.1, FEBRUARY, 1979
109
NIVATVONGS AND GOLDBERG
ANASTOMOSIS OF BOWEL ENDS OF DIFFERENT CALIBRES
Figure 1. Horizontal Mattress On larger Lumen ical Mattress On Smaller Lumen
-v-Figure 3A.I
Figure 4. Gambee Suture
110
On Smaller Lumen, Connell Suture
AUST N.Z. J. SURG VOL 49 - No 1,
FEBRUARY,1979
A TECHNIQUE OF ANASTOMOSING BOWEL ENDS WITH DISCREPANCY IN SIZE M. GOLD BERG^ Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota.
SANTHAT NIVATVONGS' AND STANLEY
There have been only a few methods devised to solve the problem of discrepancy In size of the bowel ends for anastomosis. We descrbe another method to overcome this problem b y using a one-layer open technique. For the posterior wall the anastomosis consists of a horizontal mattress suture on the larger end and a vertical mattress suture on the smaller end. For the anterior wall the Gambee suture is used.
QUITE often a surgeon encounters a situation where the two ends of bowel for the anastomosis are significantly different i n size. For years there have been only a few methods devised to solve this problem, such as the use of the Cheatle incision Barnes et alii (1975), oblique transection of the smaller end of the bowel, and the side-to-end anastomosis (Baker 1950). We have adopted a secure and simple technique to overcome this problem. TECHNIQUE This is an open anastomosis with no clamps applied on the bowel. We use one-layer full thickness, mucosal inversion anastomosis, with 4/0 polypropylene.
The posterior wa//.- A mattress suture is used, with the knots tied inside the lumen. On the larger diameter side a horizontal full thickness mattress suture is applied (Figure 1). On thesmallerdiameter side a vertical mattres is employed, with full thickness o n first bite and only submucosa and mucosa in the same vertical plane on the subsequent bite (Figure 1A). When all the sutures are tied, the larger lumen side will slightly decrease
in size, but the smaller lumen side will stretch to almost equal size with the opposite end (Figure 2). The anterior wa//.- An interrupted full thickness suture with only mucosal inversion as described by Gambee (1951) is used (Figure 3.3A). If significant difference in the size of the lumen still exists, an interrupted Connell suture is used on the larger lumen side (Figure 4 ) . During the past two years we have used this technique with satisfaction whenever needed in i l e o c o l o s t o m y , ileorectal anastomosis, and colorectal anastomosis.
REFERENCES BAKER, J. W. (1950), Arch. SUfg., 61: 143 BARNES, J. P.. GREER, C. R . andSASS0. R . D. (1975),Aflfl. Surg., 182: 650. GAMEEE,L. P. (1951). West. J. Surg., 59: 1.
'Assistant Professor of Surgery, Division of Colon and Rectal Surgery 'Clinical Professor of Surgery and Director Division of Colon and Rectal Surgery Reprints Santhat Nivatvongs, M D , Box 450, University Hospitals. Minneapolis. Minnesota 55455, U S A
AUST.N.Z. J. SURG.VOL. 49
- No.1, FEBRUARY, 1979
109
NIVATVONGS AND GOLDBERG
ANASTOMOSIS OF BOWEL ENDS OF DIFFERENT CALIBRES
Figure 1. Horizontal Mattress On larger Lumen ical Mattress On Smaller Lumen
-v-Figure 3A.I
Figure 4. Gambee Suture
110
On Smaller Lumen, Connell Suture
AUST N.Z. J. SURG VOL 49 - No 1,
FEBRUARY,1979
