Complications

There are four main complications, as follows (Table 49.7).

Haemorrhage

This can occur at the suture line or from the mesentery. The Connell suture is non-haemostatic and therefore should not be used if the cut intestine has a profuse blood supply, e.g. the stomach.

Haemorrhage can be immediate (reactionary) or late (secondary), although this is rare. If the bleeding causes systemic effects, a laparotomy must be performed and the anastomosis resected and refashioned

Leakage

Oesophageal and colonic anastomoses are most prone to leak. The outcome depends on the size of the leak and its anatomical site. As already stated, the healing of anastomoses depends on good blood supply and no tension. With colonic anastomoses a clean bowel is also necessary.

Stenosis

Stenosis can be caused by excessive inversion especially with two-layer anastomoses. An inadequate stoma in the first place or ischaemia can also lead to subsequent stenosis. Circular staples, especially double rows, are prone to cause narrowing due to rigidity.

Diverticular formation

Caused by either a weakness of the wall or from a poor blood supply, a ‘blow-out’ occurs which is contained, i.e. perfora­tion does not occur.

Although anastomoses depend on the many factors men­tioned, a good technique is probably the most important one.

Gentle handling of the tissues will ensure better healing. Anastomoses should never be rushed or performed if the above conditions cannot be fulfilled. A few extra minutes spent pays handsome dividends and may save the patient’s life. An insecure anastomosis is an unacceptable iatrogenic hazard.