The word “anastomosis” refers to a connection between two tubes or passages that would normally branch away from each other.
In medical terminology, anastomosis is when surgeons connect two tube-like structures inside the body. People may need anastomosis to join blood vessels or sections of the bowel.
Here we look at the types of anastomosis and their uses. We also outline what to expect during and after anastomosis.
The term “anastomosis” refers to a connection between two tubes or passages that would usually branch away from each other.
Anastomosis in biology
Anastomosis occurs naturally in the body, where veins and arteries connect to transport blood around the body.
Anastomosis in the vascular system creates a backup pathway for blood flow if a blood vessel becomes blocked.
Vascular fistulae are abnormal anastomoses, where blood vessels join together through injury, inflammation, or disease.
Anastomosis in medicine
In surgery, an anastomosis occurs when a surgeon or interventionalist connects two tube-like structures in the body.
- two blood vessels
- two sections of bowel
- two parts of the genitourinary tract
People may require anastomosis to:
- repair damage to veins or arteries
- create a bypass for blocked arteries
- connect a donor organ to a blood supply
- rejoin two sections of intestine after removal of damaged or diseased tissue
- treat conditions such as:
There are two main types of anastomosis: Bowel anastomosis and vascular anastomosis.
Bowel anastomosis connects two sections of the bowel or connects the bowel to other structures within the body. The different types of bowel anastomosis include:
- Intestinal anastomosis: This involves removing part of the colon and joining the two remaining sections.
- Ileocolic or ileocolonic anastomosis: This connects the end of the small intestine to the colon, usually after a bowel resection.
- Colectomy: This surgery involves removing the colon and attaching the end of the small intestine to the rectum.
- Single anastomosis gastric bypass (SAGB): People may have a gastric bypass to aid weight loss. A SAGB procedure involves turning part of the stomach into a gastric pouch and attaching it to a small loop of intestine. This restricts a person’s food intake and reduces calorie absorption.
- Hepaticojejunostomy: Connecting a hepatic duct to a section of the small bowel, permitting digestion of food following certain pathological processes that harm the bile ducts, pancreas, or the duodenum.
Vascular anastomosis connects blood vessels. There are three types:
- Arterioarterial anastomosis connects two arteries.
- Venovenous anastomosis connects two veins.
- Arteriovenous anastomosis connects an artery to a vein.
This procedure can occur to create durable dialysis access for people with kidney failure.
Surgeons often use staples or stitches when connecting tissues during an anastomosis.
Stapling is the more common method for most bowel anastomosis, as it is quicker than sewing and easier to master.
A person will be under general anesthesia for the duration of surgery that involves an anastomosis.
The type of anastomosis a person has depends on their underlying condition.
The surgeon will carry out the anastomosis during one of the following procedures:
- Laparoscopy, or “keyhole surgery”: This is a minimally invasive procedure that involves inserting a laparoscope into a small incision in the abdomen. A laporoscope is a thin, flexible tube that has a light and camera at one end. The instrument allows the surgeon to see inside the abdomen while operating.
- Open surgery or “laparotomy”: This procedure involves making a larger incision across the abdomen.
- Hand assisted laparoscopy: In this type, the surgeon makes an incision large enough to insert a hand to operate. The procedure creates a smaller incision than that required for open surgery but is more invasive than a laparoscopy.
- Robotic surgery or “robot assisted laparoscopy”: This is minimally invasive and similar to laparoscopy, but the surgeon uses a console to control a surgical robot. The chief advantage is that the system allows the surgeon more dexterity and 3D vision of the structures inside the body.
The recovery time from surgery that involves anastomosis will depend on several factors, including:
- the medical reason for the surgery
- the type of technique the surgeon used
- whether the person had any other health issues
People who have laparoscopic or robotic surgery typically experience a shorter recovery time than those who have open surgery. Both minimally invasive methods may also be less painful and result in less scarring.
Recovery from surgery can take between 6 weeks and 2 months. People should follow their doctor’s instructions to ensure they heal effectively and minimize the risk of complications.
The following may help the healing process:
- eating a healthful diet high in protein, zinc, and vitamin C to promote wound healing
- performing gentle exercises to promote circulation, assist healing, and prevent blood clots
- lifting no more than 10 pounds (4.5 kilograms) as this can impair healing and cause incisional hernias
- following the doctor’s advice for wound care at home
- taking any medications as the doctor prescribes
A potential complication of any anastomosis is leakage.
Anastomotic leakage is when the anastomosis does not heal correctly, causing internal fluid to leak out. This is a serious condition that requires immediate medical treatment.
Risk factors and symptoms
Researchers do not know the causes of anastomotic leakage. However, the following may increase a person’s risk:
- existing health problems
- poor wound healing due to smoking or diabetes
- long operation time
- previous abdominal surgery
- emergency surgery
- older age
- being male
- technical challenges
Symptoms of an anastomotic leak include:
- increased heart rate
- stomach pain
- nausea and vomiting
- difficulty breathing
- fluid leaking from a closed incision
- chest pain
- reduced urine output
- general discomfort
Doctors may use the following to diagnose an anastomotic leak:
- CT scan: This method combines a series of X-rays to produce a detailed picture of the inside of the body. CT scans may be less effective at detecting leakage than other methods.
- Contrast enema: A person receives an enema containing a contrast agent such as iodine or barium. The agent provides a detailed image of the colon during X-ray.
- Endoscopy: A doctor inserts a thin, flexible tube or endoscope into the abdomen via the rectum. The endoscope has a light and camera to allow the doctor to see inside the abdomen.
- Repeat surgery (exploration): A doctor may perform another surgery to examine the area.
Anastomotic leakage can be life threatening and requires immediate medical treatment.
In medicine, an anastomosis is when surgeons join two tube-like structures or passageways in the body. There are two main types of anastomosis: bowel, and circulatory.
Recovery from an anastomosis may take between 6 weeks and 2 months. During this time, a person will need to follow their doctor’s instructions for wound care to ensure proper healing.
In some cases, people may experience complications of anastomosis. Anyone who experiences symptoms of anastomotic leakage should seek immediate medical treatment.