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Side to Side Anastamosis

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Posted 2/18/2011 7:32 PM (GMT 0)
In talking to my GI last night, he told me that I had a side to side anastamosis. This was a new one on me, so of course I have been doing some research today. It would appear to be part of the problem that I am having because it contributes to the formation of a pouch at the site of the anastamosis. But I can't really find all that much information, and of course I have no idea why the surgeon who did my resections did it side to side instead of end to end, or side to end, or which is really the best way. These are all questions I will have for my new Colo-rectal surgeon in March. I'm just putting it out there for any others who might be facing surgery as something to ask about.

And if any one knows anything about it, I would love to know more.
Posted 2/18/2011 11:59 PM (GMT 0)

I did a little research too and might have found some rationale for the side to side decision. From http://www.uptodate.com/contents/surgical-management-of-inflammatory-bowel-disease/abstract/95

"CONCLUSIONS: End-to-end anastomosis after resection for Crohn's disease may be associated with increased anastomotic leak rates. Side-to-side anastomosis may lead to fewer anastomotic leaks and overall postoperative complications, a shorter hospital stay, and a perianastomotic recurrence rate comparable to end-to-end anastomosis. Further randomized, controlled trials should be performed for confirmation."

 

Posted 2/19/2011 4:08 AM (GMT 0)
Mine is end to side. I wonder if that's a good anastomosis!!
Posted 2/19/2011 12:56 PM (GMT 0)
dunny, that is just it, I don't know if one is better than an other. I just thought it was interesting that there were several choices and one more thing to ask a doctor about if you need surgery.

I am specifically having an issue with a pouch forming because of adhesion or scar tissue. This seems to be one complication of side to side surgery. However, that may have been the only way my surgery could have been done. And I've gotten 12+ years out of it, so who's to say that isn't a good run. Just putting it out there for food for thought.
Posted 2/19/2011 1:37 PM (GMT 0)
Suzanne, because there are so many choices, I think it probably comes down to surgeon preference.
I'm now on my 8th year, but I am flaring, so I don't know what sort of outcome I will have this time.
Mainly because my disease has skipped, so now it's in the TI and the lower end of the sigmoid, about
25cm's in from the rectum. Slightly worrying....
Posted 3/17/2011 3:36 PM (GMT 0)
Zanne, what type of anastomosis did you end up having?

A few years ago, I had end to end and developed a tight stricture within a year or so, this time I had side to side, and as you know I still have LRQ pain too and wonder if it's food passing or a bit of an obstruction. My stools are very narrow with "d" too. I'm hoping and praying that the anastomosis will work out and heal properly and be nice and wide.

Did anyone else have narrow stools for a while after resection?
Posted 3/17/2011 3:49 PM (GMT 0)
Roni, when I do see stool (usually just fluid) mine are also very narrow, but as I mentioned in the above
post, I now have inflammation and ulcers in the sigmoid too, so I don't know whether that would be the reason
or the inflammation/ulceration at the anastamosis site (side to end).

Yeah Suzanne, do you know what you had this or was your surgery for adhesions?
Posted 3/17/2011 8:16 PM (GMT 0)
I had another side to side. I really don't know if one is considered better than another if it is just a case of using which ever one seems to fit the situation. I guess only time will tell if this is the right configuration for me.
Posted 3/17/2011 9:50 PM (GMT 0)
I had a side-to-end resection in 1978. I had waited until I had a full obstruction and had been battling a high grade partial obstruction so the area above the obstruction had stretched out quite a bit. I was told the side-to-end anastomosis was to allow for less intestine to be removed. They only had to resect the actively diseased area. Ever try to join a 1 inch hose to a 3 inch hose?? That also allows for a wider anastomosis so theoretically at least it will take longer for scar tissue to cause new narrowing.

This is sorta the idea behind strictureplasty as well. IF there is narrowing due to scar tissue and disease in the area is dormant strictureplasty allows widening of the narrowed area w/o having to remove any intestine. At least this is my understanding of the side-to-side, side-to-end and strictureplasty surgeries.

Posted 3/17/2011 9:53 PM (GMT 0)
about narrow stools. Think about it. The circumference of the stool is determined by the tightness of the rectal and anal muscles and the consistency of the stool. Very firm stool can open the mucles more than soft less formed stool.
Posted 3/18/2011 3:58 PM (GMT 0)
Hey,,your suppose to be much better by now Ms Suzanne.....Side by side, side to end, end to end, I feel dizzy. I think my rectal nerve was reconnected to my optic nerve giving me a crappy outlook on life right now so , just hopeing you feel better and your side to side and end to side stops doing the two step or the rumba or whatever its doing real soon.
Posted 3/18/2011 9:50 PM (GMT 0)

:)

I've talked with two surgeons about that options and both prefer side to side. They say something about risks and passage opening.

It seems you have also more options to staple the opening connection area. Mine is side to side too (2 years old surgery).

Posted 3/18/2011 9:58 PM (GMT 0)
CT, that makes sense about the narrow stools formed by rectum and anus. Since I've had mild CD in the rectum, I have a slight fear about a bit of scar tissue build up there. Hopefully not, though.
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