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SURGERY - PROCEDURES, COMPLICATIONS, AND RESULTS
ANASTOMOSES
TYPES, TECHNIQUES/PROCEDURES,
CLINICAL OUTCOMES
AND COMPLICATIONS
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liability is assumed for incidental or consequential damages in connection with or arising out of information
contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in
rendering legal, medical or any other professional services.
SURGERY - PROCEDURES,
COMPLICATIONS, AND RESULTS
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under the e-book tab.
SURGERY - PROCEDURES, COMPLICATIONS, AND RESULTS
ANASTOMOSES
TYPES, TECHNIQUES/PROCEDURES,
CLINICAL OUTCOMES AND
COMPLICATIONS
FRANCES C. KING
AND
MCKINLEY A. MALLOY
EDITORS
New York
Copyright © 2013 by Nova Science Publishers, Inc.
All rights reserved. No part of this book may be reproduced, stored in a retrieval system or
transmitted in any form or by any means: electronic, electrostatic, magnetic, tape,
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The Publisher has taken reasonable care in the preparation of this book, but makes no
expressed or implied warranty of any kind and assumes no responsibility for any errors or
omissions. No liability is assumed for incidental or consequential damages in connection
with or arising out of information contained in this book. The Publisher shall not be liable
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the readers’ use of, or reliance upon, this material. Any parts of this book based on
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applicable to compilations of such works.
Independent verification should be sought for any data, advice or recommendations
contained in this book. In addition, no responsibility is assumed by the publisher for any
injury and/or damage to persons or property arising from any methods, products,
instructions, ideas or otherwise contained in this publication.
This publication is designed to provide accurate and authoritative information with regard
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other expert assistance is required, the services of a competent person should be sought.
FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A
COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF
PUBLISHERS.
Additional color graphics may be available in the e-book version of this book.
Library of Congress Cataloging-in-Publication Data
Library of Congress Control Number: 2013935913
Published by Nova Science Publishers, Inc. † New York
)ISBN: (eBook)
Contents
Preface vii
Chapter I Bilioenteric Anastomoses 1
Miguel Ángel Mercado
and Julio Alfaro Varela
Chapter II Intestinal Anastomosis Education and Training 47
José C. Manuel-Palazuelos, Federico Castillo,
Carlos Gavilanes, Manuel Gómez-Fleitas
and Juan C. Rodríguez-Sanjuán
Chapter III Invaginating Colonic Anastomosis 77
Aly Saber
Chapter IV Expandable Devices for Easier, Quicker and More
Efficient Aortic-Prosthesis Anastomosis 103
Stefano Nazari
Chapter V Bowel Anastomosis: Types, Techniques/Procedures,
Clinical Outcomes and Complications 139
Jair Santos-Torres, Jaime Ruiz-Tovar,
Antonio Arroyo and Rafael Calpena
Index 161
Preface
In this book, the authors present current research in the study of the types,
techniques/procedures, clinical outcomes and complications of surgical
anastomoses. Topics discussed include bilioenteric anastomoses; intestinal
anastomosis education and training; invaginating colonic anastomosis;
expandable devices for easier, quicker and more efficient aortic-prosthesis
anastomosis; and potential postoperative complications associated with bowel
anastomosis.
Chapter I – Bilioenteric anastomoses (BEA) are a frequent surgical
procedure performed under different scenarios. The main objective of BEA is
to allow adequate bile outflow into the gastrointestinal tract and prevent future
biliary strictures that will compromise adequate bile drainage, leading to
repeated episodes of cholangitis, secondary biliary cirrhosis and death.
Indications for this procedure include benign diseases (strictures of the biliary
tract, iatrogenic bile duct injuries, choledochal cysts) and malignant diseases
(pancreatic cancer and distal cholangiocarcinoma). Since Winiwaters’ first
description of a bilioenteric reconstruction more than 100 years ago, major
technical advances have occurred through time. Bilioenteric anastomoses can
be classified as extra-hepatic and intra-hepatic, depending of the anatomical
area of the biliary tract used. Extra-hepatic anastomoses include
choledochoduodenostomy, choledochojejunostomy, and hepatojejunostomy.
Intra-hepatic anastomoses include hepaticojejunostomy (Hepp-Couinaud) and
peripheral cholangiojejunostomy (Longmire-Sanford). The Hepp-Couinaud
technique is the most frequently performed anastomosis. This approach
exposes the extra-hepatic course of the left hepatic duct and allows a wide
anastomosis to a Roux-en-Y jejunal loop. The use of trans-anastomotic stents
is no longer necessary and has limited indications. Complications of BEA
Frances C. King and McKinley A. Malloy
viii
include cholangitis, biliary fistula, intra-abdominal abscesses and strictures.
Long-term follow-up report excellent results in 90% of the patients. Sixty-five
percent of recurrent strictures develop during the first 2 years and 80% during
the first 5- years after surgery. In this chapter the authors present the most
frequently BEA techniques performed, their complications and outcome.
Chapter II – The aim of a gastro-intestinal suture is to provide a hermetic
closure in the intestine or in an anastomosis.
To achieve a successful suture, a proper technique is essential, with strict
adherence to surgical principles, such as suture tension, border vascularization
and intestinal diameter. Also the patient biological condition has to be
considered. All of these factors influence suture healing but the experience and
skill of the surgeon are probably most important in the final outcome of the
anastomosis.
Until recently the learning of any surgical procedure was based on direct
operation on the patient, with initial supervision by an experienced surgeon.
This has several drawbacks such as risks for the patient, long learning curves
and an increase in operating room costs because of greater operation times.
Laparoscopic procedures need even longer and more complex training periods
due to the lack of tactile sensation and two-dimension view. The problem is
even greater in the case of residents who are less experienced in surgery in
general. To speed up learning and avoid direct training on patients, training
laboratories have been designed, where physical and virtual reality simulators
can be used.
The usefulness of training using simulation in basic surgical techniques
has been shown in improving general surgical skills and performance of
intestinal anastomosis with synthetic materials. Training in intestinal
anastomosis using dead animal viscera is very similar to the clinical setting
and has advantages over other options such as live animals, simulators or
corpses. The training on live animals reproduces real clinical settings although
it has drawbacks such as high costs or the sacrifice of the animal. Cadaver
surgery is also very similar to real clinical settings but is hardly available.
Virtual reality is very different from real clinical settings and evidence for
validation of most designed devices is lacking. These models could be used as
the first contact with laparoscopic training, according to the conclusions of the
systematic reviews published to date. However, the advantage in resident
training with some laparoscopic experience has not been shown. On the other
hand these systems are expensive, although less so than direct training on
patients.