Anastomosis

An anastomosis (uh-NAS-toh-MOH-sis) is a surgical connection between two tubes in your body. This could be between two blood vessels or between two parts of your intestines. Those are the most common types, but there are many others.

Your body already has natural connections like this. But a surgeon may need to create a new connection. This often happens after removing damaged or diseased tissue.

By joining the healthy ends together, your surgeon can help restore normal flow. If there’s a blockage, they may create a new pathway that goes around it.

Types of anastomosis

Types of surgical anastomosis include:

• Intestinal anastomosis: This is the most common type. It connects one part of your intestine to a different part of your gastrointestinal (GI) tract.
• Vascular anastomosis: This is the second most common type. It connects two blood vessels, like arteries or veins.
• Urinary anastomosis: Your surgeon reconnects parts of your urinary system, like your ureter, bladder or urethra.
• Airway (respiratory) anastomosis: Your surgeon reconnects your windpipe or breathing tubes after surgery.
• Biliary anastomosis: Your surgeon connects bile ducts so bile can flow normally from your liver.
• Nerve anastomosis: Your surgeon reconnects nerves to help restore feeling or movement.
• Tendon anastomosis: Your surgeon connects tendons to help muscles move again.

Which procedures involve surgical anastomosis?

Some common examples include:

• Bowel resection
• Ileal pouch
• Gastric bypass surgery
• Arterial bypass surgery
• Dialysis fistula
• Organ transplantation

When is an anastomosis not recommended?

If you have inflamed tissue due to disease or infection, your surgeon may wait before creating a surgical connection. This gives the tissue time to heal.

In some cases, your surgeon will create an ostomy instead. This diverts waste to an opening in your belly. There, it drains into an ostomy bag.

What happens during this procedure?

Surgeons can connect tubes in your body in a few different ways. They may use:

• End-to-end anastomosis: Your surgeon connects two open ends to form a seamless tube.
• Side-to-side anastomosis: Your surgeon connects two tubes side by side. Then, they close their ends.
• End-to-side anastomosis: Your surgeon connects one open end to the side of the other tube. Then, they’ll close the open end of that tube.

What are the possible risks or complications of anastomosis surgery?

All surgical procedures carry certain standard risks, including:

• Bleeding
• Blood clots
• Inflection
• Injury to nearby organs or vessels

There are two complications specific to anastomosis surgery: anastomotic strictures and anastomotic leaks.

Anastomotic stricture (stenosis)

An anastomotic stricture happens when scar tissue forms at the surgical connection and narrows the tube. This can slow down or block the movement of food, pee or other fluids.

Stenosis can also occur in the neck of your bladder after prostate surgery. It occurs when your urethra is connected to your bladder neck. This is called bladder neck contracture.

In both cases, healthcare providers can often treat the stricture by widening it with a balloon, or with tubes.

Anastomotic leak

An anastomotic leak happens when the new connection doesn’t seal completely. This allows fluids or waste to leak into nearby tissue.

This is serious because these substances can damage your body if they leak out. For example, bacteria from your intestines can cause an infection if they leak into your belly.

What happens after this procedure?

After surgery, you’ll spend time in the hospital so your care team can watch your recovery. How long you stay depends on the type of surgery you had and how well you heal.

At first, you may not be able to eat or drink normally. Your healthcare providers will slowly reintroduce liquids. Then, you can start solid foods as your body heals. They’ll also watch for signs of problems. These could be infections or leakage at the surgical connection.

You may have pain, swelling or tiredness while you recover. Your providers will give you medicine and instructions to help manage your discomfort. Most people can slowly return to normal activities over time. Full recovery may take several weeks.

When should I call my healthcare provider?

Call your healthcare provider right away if you notice any of the following symptoms after surgery:

• Fever or chills
• Worsening pain that doesn’t get better with medicine
• Redness, skin discoloration, swelling or drainage from the cut
• Nausea or vomiting that won’t stop
• Belly pain or swelling
• Trouble peeing, pooping or passing gas
• Signs of infection, like warmth, pus or a bad smell from the wound

These symptoms may be signs of a complication. Your provider should check them out as soon as possible.