VM38 - Hand-Sewn Bowel Anastomosis: A Comprehensive Technique for Optimal Outcomes in Colorectal Surgery

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Purpose/Background: Bowel anastomosis is a critical component of colorectal surgery, with various techniques available to achieve this connection. The hand-sewn anastomosis, despite the availability of stapled methods, remains a fundamental skill due to its potential benefits in certain scenarios. While studies and meta-analyses have indicated no significant difference in complication rates between stapled and hand-sewn anastomoses, the latter technique offers advantages such as larger luminal diameters and potentially improved healing outcomes. This video vignette illustrates the application of the hand-sewn technique in performing a colo-colonic, end-to-end anastomosis.

Methods/Interventions: The video demonstrates the hand-sewn technique following lesion resection. Initially, proper enterotomies are created at both ends of the resected colon segments. The posterior wall of the anastomosis is secured using simple interrupted sutures to ensure seromuscular apposition. A full-thickness single-layer simple interrupted suture with 3-0 silk is then used to approximate the posterior wall from the midpoint towards the anastomotic angles, maintaining consistent tension and ensuring hemostasis. For the anterior wall, 3-0 silk interrupted vertical mattress sutures are employed to invert the mucosa and achieve a watertight seal. Attention is given to maintaining good blood supply and minimal tension throughout the procedure.

Results/Outcomes: The video highlights a successful execution of the hand-sewn anastomosis technique, demonstrating its application across various anastomotic configurations, including side-to-side, end-to-end, and side-to-end. The use of continuous and interrupted sutures ensures a secure and leak-proof connection with optimal hemostasis and tissue integration.

Conclusion/Discussion: The hand-sewn bowel anastomosis technique, as demonstrated in this video, remains a valuable skill in the colorectal surgeon’s repertoire. It offers versatility and adaptability in various surgical contexts, reinforcing its relevance despite the advancement of stapled techniques. The method’s potential benefits in terms of luminal diameter and healing underscore its importance in achieving successful surgical outcomes.