الفهرس 
Anatomical and physiological considerationOnly 14 pages are availabe for public view
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Abstract
Despite the development of suture materials and advances
in medical technology. gastro intestinal anastomoses continue
to represent a challenge to the general surgeons.
The two layer technique is still the method used by the majority
of surgeona for anastomosis in esophagus. stomach. duodenum
and small intestine. Leakage rates was considerably
greater when a two layer technique was used for low colorectal
anastomoses. It is undoubtedly true that it is much easier
to perform an anastomoses in the pelvis with single layer
technique and when the suture line is extremely low such a
single layer is the only feasible technique. It is evident
that there is no significant difference in the incidence of
anastomotic breakdown with either two layer or one layer techniques.
when the anastomoses was performed above the pelvic
peritoneal reflection. for anastomoses low in the pelvis.
the single layer interrupted technique is made with less
tissue trauma. less disturbance of circulation and is simple,
safer and effective. Various stapling instruments are now
widely used for gastrointestinal anastomoses. All staples
are inserted by single application, Circular stapling devices
especially the American EEA stapling gun are particularly
useful when performing low colorectal anastomoses in men with
narrow pelvis. This study has answered some but not all of
our questions about this technique. We are resonably satisfied
that the stapled suture line is a secure in all respects
as the hand sewn anastomoses. We are not sure however, that
the stapled line is more secure. Mechanical stapling instruments
do not absolve the surgeon from respecting the golden
rules of operative surgery such .~ clean, sharp, atrumatic
dissection, careful haemostasis, respect for tissue viability
and blood supply, use of healthy, disease free tissue in sutures,
and anastomoses placed without tension. So that the
teaching and learning of principlas and clearer understanding
of the differences between the principals and methods of anastomoses,-
should be facilitated and highlighted by an opportunity
to use staples in addition to thread early in the residency
experience. The instruments will not permit the safe
performance of operative maneuvers by untrained or unskilled
personnell. nor do they eliminate the necessity for rigorous
surgical training. due regard for tissues. and of course
training in the various manual techniques of resection and
anastomoses.
Recently there has been some interest in the use of
tissue adhesives for the performance of ” non suture ” anastomoses.
One of the supposed advantages of the adhesive technique
is its greater speed. In view of the known safety of
suture anastomoses of any type. it would seem that the adhesive
anastomoses should not be employed untill better adhesives
have been evolved. Despite the good results obtained in esophago
jejenostomy after total gastrectomy and in the treatment
of bleeding esophageal varices by application of magnetic
rings. the proceudre was never generally applied. It appears
that type and incidence of complications. rate of anastomotic
failure. and mortality rates are usually determined by faotors
other than the method or materials used in sewing the bowel.
Doutless. surgeons will continue to tie knots. but
just .$,Ifoogmusic has entered the classical concert hall. so
the staple will have its place in the operating theatre.