Anastomosis is connecting two different tubes together. Such connections are present naturally within the body. Sometimes, they are surgically created to bypass or replace a damaged portion. Anastomosis is mainly done in the bowel or blood vessels and can be of different types. It is up to the surgeon to choose the correct procedure suitable for the patient’s condition.
What Is Surgical Anastomosis?
Anastomosis is the creation of a connection between two tube-like structures by the surgeon. Anastomosis is usually made when there is damage to a part of an organ that is surgically removed, which then requires the remaining parts to be connected for normal functioning. It is also done in cases where a new pathway is needed to bypass the original blocked pathway. Hence, the surgeon can create an anastomosis between two arteries, two veins, two parts of the intestine (bowel), or two parts of the digestive tract.
Are Anastomoses Always Created Surgically?
Anastomosis is not always created surgically. It is also naturally present in the body where the arteries or veins are connected to carry the blood to all body parts. There is a structure called the circle of Willis, an example of a natural anastomotic connection. It connects the two internal carotid arteries and two vertebral arteries. These are the main arteries that supply the brain. The arrangements of the arteries are in such a way that it creates a backup supply of blood to the brain, even if any one of the arteries gets blocked or damaged. This ensures a continuous supply of oxygenated blood to the brain to prevent cerebral ischemia (an injury to the brain due to inadequate blood flow).
Why Is Surgical Anastomosis Required?
The surgeon recommends a surgical anastomosis in the following situations:
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For repairing damage to the arteries or veins.
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For creating a blood supply to a donor organ after transplantation.
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To create a bypass to the blocked arteries.
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For connecting two parts of the bowel after removing the damaged section.
It is used in managing the following conditions:
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Inflammatory bowel diseases (diseases that cause inflammation to the digestive tract) such as Crohn's disease and ulcerative colitis.
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Intestinal polyps (polyps are overgrowths in the lining of the intestine).
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Intestinal cancer.
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Traumatic injury to any body part.
When Is Surgical Anastomosis Not Indicated?
After surgery of removing an artery or a part of an intestine, the anastomosis may not be recommended to be performed on the same day of surgery. This is because of inflammation, which requires some time to heal. During the healing time, an ostomy (a surgical opening created on the body) can be used to divert the contents. After complete healing occurs, the surgery for anastomosis is performed, and the ostomy is closed.
What Are the Different Types of Surgical Anastomosis?
Anastomosis is mainly of three types:
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End-To-End Anastomosis - Here, the surgeon connects two open ends to form a single tube.
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Side-To-Side Anastomosis - The sides of two parts are connected rather than two ends. The ends of both sides are closed.
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End-To-Side Anastomosis - This connects one end to the side of another tubular structure. The two open ends of the side channel are closed.
The surgeon decides which type of anastomosis to use depending on the diameter of the parts to be connected. Anastomosis is most often created in the bowel or the vascular system.
- Bowel Anastomosis (Intestinal Anastomosis) - It is a procedure to reconnect two parts of the bowel or to other structures in the digestive tract to establish continuity. Some of the surgical anastomosis procedures in the bowel include:
- Intestinal Anastomosis: Involves replacing the removed, damaged part by connecting the other two ends of the intestine.
- Ileocolonic Anastomosis: Connects the ends of the small intestine to the large intestine. Bowel resection surgery requires this type of anastomosis to maintain a ceaseless flow of intestinal contents.
- Colectomy: Here, the colon (large intestine) is completely removed. So, the small intestine is connected to the rectum.
- Single Anastomosis Gastric Bypass: Gastric bypass surgeries help bypass a part of the digestive tract, usually done in most weight loss procedures. In this type of anastomosis, the upper part of the stomach is attached to a tube (that forms a new smaller stomach) and connected to the lower part of the intestine. This helps keep the remaining portion between the stomach and the lower part of the intestine to be bypassed.
- Hepaticojejunostomy: It refers to the anastomosis between the hepatic duct (liver duct) and the jejunum (a part of the small intestine). This procedure is done in conditions where the bile duct is damaged, and hence the connection between the duct directly to the jejunum ensures the free flow of bile.
- Vascular Anastomosis - The connection between blood vessels when one gets injured or blocked. Some of the surgical anastomosis procedures in the vascular system include:
- Arterio Arterial Anastomosis: Connecting two arteries.
- Venovenous Anastomosis: Connecting two veins.
- Arteriovenous Anastomosis: Connecting an artery to a vein.
The procedures that require vascular anastomosis are:
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Arterial Bypass Surgery - It redirects a damaged artery by connecting the normal functioning artery to an artery or vein graft from another body site. Hence, the donor and the recipient site both require anastomosis.
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Dialysis - In dialysis, access is created between the dialysis machine and the patient's bloodstream by anastomosis between two blood vessels (artery and vein). Such a connection is called an arteriovenous fistula.
How to Perform a Surgical Anastomosis?
The doctor determines the patient's condition and provides the proper treatment accordingly. The whole procedure is done under general anesthesia. The surgery can be done using any of the following types:
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Laparoscopic or Keyhole Surgery: The surgeon uses a laparoscope (fiber-optic instrument with a camera attached). An incision is made, and the laparoscope is introduced through the incision. The surgeon can visualize the structures in the operating site with the camera. This procedure involves small incisions, is painless, and has faster healing.
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Laparotomy or Open Surgery: This procedure uses a larger incision. Hence, postoperative pain may occur, and the recovery rate is slower.
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Hand-Assisted Laparoscopy: This technique uses an incision greater than the laparoscopic surgery but smaller than the open surgery. The surgeon inserts the hand through the incision and does the procedure.
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Robotic Surgery: This allows the doctor to perform the surgery with great precision and is minimally invasive.
How Is the Recovery After Surgical Anastomosis?
The complete recovery can take anywhere from six weeks to twelve months. Open surgery takes a longer time to heal. The basic instructions to be followed after discharge from the hospital include:
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Maintaining a healthy diet.
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The surgeon prescribes painkillers that must be consumed regularly.
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Gentle exercises, as instructed by the surgeon, must be followed to maintain a good blood flow.
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The patient must avoid doing heavy exercises that put too much strain on the body.
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Patients with smoking and alcohol habits must quit them.
What Are the Complications of Surgical Anastomosis?
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General Complications: Like bleeding, infection, injury to adjacent organs or vessels, and allergic reactions may occur.
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Anastomotic Leak: One of the major complications of anastomosis that requires immediate treatment. When the anastomosis is not healed completely, the contents or fluid passing through it may leak. This is more common with bowel anastomosis. The cause for the leak can be due to poor wound healing, malnutrition, or any underlying medical illness. These patients require another surgery to repair the leakage.
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Anastomotic Stenosis: Stenosis refers to the narrowing or blockage of the anastomosis. The presence of scar tissue within the anastomosis will lead to its narrowing. These can be treated using a balloon to dilate or widen the pathway of anastomosis.
Changes that occur with the operated site, such as leakage, infection, pain, or any discomfort, must be brought to the surgeon's notice immediately. This helps the surgeon find the cause and provide treatment to prevent further complications.
Conclusion
Surgical anastomosis is a connection between two tubular structures created by humans through surgery. It may seem easy, but it requires accurate technique and flexibility to perform the surgery without complications. Complications are rare, but if they occur, the surgeon must be ready to manage them immediately. Overall, the outcome of the surgery is good and helps to establish continuity and functionality.
