The anastomosis is defined as the creation of a connection between two hollow organs or areas of an organ, with the goal of viscerosynthesis, an anatomical-physiological reconstruction.
For the success of an operation, the correct suturing technique is a fundamental prerequisite.
There is no binding standard for creating a gastrointestinal anastomosis. The question of the right technique is answered individually.
The requirements for an ideal anastomosis are, however, clearly defined:
- Impeccable anastomosis technique
- Good arterial and venous blood flow
- Tension-free
- Clean operative field
Any compromise in the absence of one of these prerequisites means the risk of anastomosis insufficiency with all the resulting consequences.
The adhesion of the serosal surfaces of an intestinal anastomosis occurs through fibrin exudation normally in the first 4-6 hours and leads to a gas- and liquid-tight closure. The mechanical strength in this first phase of anastomosis healing is primarily provided by the suture material.
The small intestine has a significantly faster reaction to an injury to the intestinal integrity than the large intestine, which is shown in a faster collagen production and can partly explain the higher rate of early insufficiencies in colorectal surgery.
The neovascularization begins on the 4th to 5th postoperative day and originates essentially from the submucosa, the vascular-bearing layer of the intestinal wall. It supports the suture in this phase of wound healing through its collagen richness. The suture finds its hold here at this time.
Adequate mobilization to achieve a tension-free approximation of well-perfused intestinal ends is an absolute prerequisite. Extensive skeletonization must be avoided.
The row count in hand-sewn anastomoses describes the number of suture rows, the layering the penetrated wall layers.