Intestinal Segments and Urinary Diversion: Difference between revisions

*** The anastomotic stapler places two linear double rows of staggered staples. When the knife is advanced, the staple line is divided. The height of the staples is also chosen according to the tissue to be transected. Most intestinal anastomoses are performed with medium staples, which have a closed height of  ≈1.5 mm (open height of 3.5 mm).

*** Ileocolonic Anastomosis with the Circular Stapling Device

**** Summary of steps:

***** The antimesenteric border of the two bowel segments to be joined is approximated with a 3-0 silk suture 5 to 6 cm from the cut ends of the bowel. A holding suture is placed through both segments of bowel at their cut ends at the midpoint of the antimesenteric borders. Stay sutures are placed at the mesenteric border of each bowel segment, and two other sutures midway between the mesenteric and antimesenteric border on the lateral aspects of the bowel are also placed. The anastomotic stapler is positioned in the lumens of both segments of bowel along the antimesenteric border. The antimesenteric holding suture is pulled up adjacent to the stapler. The anastomotic stapler is locked in place, the staples are fired, and the knife is advanced. The staple lines are inspected for bleeders, which if persistent should be suture ligated with an absorbable suture. It is important for several 3-0 silk sutures to be placed at the apex of the stapled and cut antimesenteric incision. At this point, slight tension on the anastomotic line can place undue stress on the staple margin and cause a leak. The holding sutures are held up, and a linear stapler is placed across the open end of bowel and fired. Care must be taken so that the staples include the serosa in its entire circumference. Excess bowel tissue is excised flush with the instrument before it is disengaged. The mesentery is then reapproximated.