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World J Gastroenterol. Apr 7, 2010; 16(13): 1610-1621
Published online Apr 7, 2010. doi: 10.3748/wjg.v16.i13.1610
Techniques for colorectal anastomosis
Yik-Hong Ho, Mohamed Ahmed Tawfik Ashour
Yik-Hong Ho, Mohamed Ahmed Tawfik Ashour, Discipline of Surgery, School of Medicine, James Cook University, Townsville, QLD 4811, Australia
Author contributions: Ho YH and Ashour MAT contributed equally to this review.
Correspondence to: Yik-Hong Ho, MD, FRCSEd, FRCS (Glasc.), FRACS, FICS, Professor and Head of Surgery, Discipline of Surgery, School of Medicine, James Cook University, Clinical School 1MB52, Angus Smith Dr, Douglas, Townsville, QLD 4811, Australia.
Telephone: +61-7-47961417   Fax: +61-7-47961401
Received: December 15, 2009
Revised: January 20, 2010
Accepted: January 27, 2010
Published online: April 7, 2010

Colorectal anastomotic leak remains one of the most feared post-operative complications, particularly after anterior resection of the rectum with, the shift from abdomino-peritoneal resections to total mesorectal excision and primary anastomosis. The literature fails to demonstrate superiority of stapled over hand-sewn techniques in colorectal anastomosis, regardless of the level of anastomosis, although a high stricture rate was noted in the former technique. Thus, improvements in safety aspects of anastomosis and alternatives to hand-sewn and stapled techniques are being sought. Here, we review alternative anastomotic techniques used to fashion bowel anastomosis. Compression anastomosis using compression anastomotic clips, endoluminal compression anastomotic rings, AKA-2, biofragmental anastomotic rings, or Magnamosis all involve the concept of creating a sutureless end-to-end anastomosis by compressing two bowel ends together, leading to a simultaneous necrosis and healing process that joins the two lumens. Staple line reinforcement is a new approach that reduce the drawbacks of staplers used in colorectal practice, i.e. leakage, bleeding, misfiring, and inadequate tissue approximation. Various non-absorbable, semi or fully absorbable materials are now available. Two other techniques can provide alternative anastomotic support to the suture line: a colorectal drain and a polyester stent, which can be utilized in ultra-low rectal excision and can negate the formation of a defunctioning stoma. Doxycycline coated sutures have been used to overcome the post-operative weakness in anastomosis secondary to rapid matrix degradation mediated by matrix metalloproteinase. Another novel technique, the electric welding system, showed promising results in construction of a safe, neat, smooth sutureless bowel anastomosis. Various anastomotic techniques have been shown to be comparable to the standard techniques of suturing and stapling. However, most of these alternatives need to be accepted and optimized for future use.

Keywords: Alternative anastomosis, Compression anastomotic clip, Compression anastomotic ring, Biofragmental anastomotic ring, AKA-2, Magnamosis (magnetic anastomosis), Matrix metallo-proteinase, Sutureless