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.