- Surgical anastomosis
In surgical jargon, to create an
anastomosis is to join together two hollow organs (viscus), usually to restore continuity after resection, or to bypass an unresectable disease process. Historically such procedures were performed with suture material, but increasingly mechanical staplers and biological glues are employed. While an anastomosis may be end-to-end, equally it could be performed side-to-side or end-to-side depending on the circumstances of the required reconstruction or bypass.Anastomosis are typically performed on:
* Blood vessels:
Arteries andveins . Most vascular procedures, including allarterial bypass operations (e.g.coronary artery bypass ),aneurysmectomy of any type, and all solidorgan transplants require vascular anastomoses.* Gastrointestinal (GI) tract:
Esophagus ,stomach ,small bowel ,large bowel ,bile ducts , andpancreas . Virtually all elective resections of gastrointestinal organs are followed by anastomoses to restore continuity;pancreaticoduodenectomy is considered a massive operation, in part, because it requires three separate anastomoses (stomach, biliary tract and pancreas to small bowel). Bypass operations on the GI tract, once rarely performed, are the cornerstone ofbariatric surgery . The widespread use of mechanical suturing devices (linear and circularstaplers ) changed the face of gastrointestinal surgery.* Urinary tract:
Ureters ,urinary bladder ,urethra .Radical prostatectomy andradical cystectomy both require anastomosis of the bladder to theurethra in order to restore continuity.*
Microsurgery : The advent of microsurgical technique allowed anastomoses previously thought impossible, such as so-called "nerve anastomoses" (not strictly an anastomosis according to the above definition), and operations to restore fertility aftertubal ligation orvasectomy .Fashioning an anastomosis is typically a complex and time-consuming step in a surgical operation, but almost always crucial to the outcome of the procedure.
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