Anastomotic technique, gastrointestinal, side-to-side, open, continuous hand suture, double layer - general and visceral surgery

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  • Selecting the intestinal loops


    The technique is demonstrated here by a Braun anastomosis as part of a classic Whipple procedure. The anastomosis is fashioned in two layers. Follow this link Segmental jejunal resection with side-to-side anastomosis  to see a single-layer variant of this anastomosis.

  • Intestinal suture step 1A - double-layered suture - posterior wall


    A so-called non-rotating technique is used here.
    It consists of a double-layer full-thickness suture, with the posterior wall being sutured first. The suture material is PDS 5/0.

    Start with a seromuscular running suture apposing both posterior walls.

    Keep the suture ends as stay sutures for orientation in the next step.

  • Intestinal suture step 1B - double-layered suture - posterior wall

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    Now open the jejunum with the electrocautery on both sides of the suture placed previously.

    As the next step, place a full-thickness running suture on the inside of the posterior wall.

  • Intestinal suture step 2A - double-layered suture - anterior wall

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    Follow this with the inner full-thickness running suture of the anterior wall. Stitch direction is always from the outside in and from the inside out. Invert the mucosa into the lumen with the forceps when tying the suture.

  • Intestinal suture step 2B - double-layered suture - anterior wall

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    Follow this with the outer seromuscular running suture of the anterior wall.

  • Inspecting the anastomosis

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    Now check the suture line and if necessary, place additional stitches wherever direct serosa-serosa contact is lacking.

    Follow this by checking the anastomosis for any leakage (by forcing intestinal gas and fluid through it). And finally, check the width of the lumen by gently palpating the site of the anastomosis between the tips of the thumb and index finger.