ASCRS Ch09 — Anastomotic Construction

Citation: Vargas HD, Margolin DA. "Anastomotic Construction." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. pp. 157–187 (PDF pp. 169–199 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF).

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Ninth chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). A technique-focused chapter covering the physiology of anastomotic healing, fundamental construction principles (tension-free, well-perfused, airtight), mobilization techniques (small bowel, splenic flexure, high-vs-low IMA ligation, retroileal anastomosis/ileal mesenteric window, right colon de-rotation/Deloyer's procedure), perfusion assessment (clinical and ICG fluorescence angiography), anastomosis configuration (end-to-end/end-to-side/side-to-side, Cheatle slit, Barcelona anastomosis, Kono-S anastomosis, low pelvic anastomosis reservoir options), methods of construction (sutured/hand-sewn vs. stapled vs. compression ring), and a detailed review of the conflicting stapled-vs-hand-sewn leak-rate evidence across multiple registry studies. Explicitly a companion to ASCRS Ch10 ("Anastomotic Complications," not yet ingested), which the chapter's own text and this wiki's General Postoperative Complications page both defer leak management detail to.

Key content

Full synthesis written into the new procedure page Anastomotic Construction rather than summarized twice here. Cross-links added to existing pages rather than duplicating: Crohn Disease's brief Kono-S mention gains full construction technique detail; Colon Cancer Resection's high-vs-low IMA tie content (genitourinary-nerve framing) gains a complementary mesenteric-length framing; Low Anterior Resection Syndrome (LARS)'s reservoir options gain outcome-comparison data, partially filling a previously-flagged open item; Ileal Pouch-Anal Anastomosis (IPAA) and Total Mesorectal Excision (TME) & Sphincter-Sparing Resection both gain pointers to this page's general stapled-vs-hand-sewn discussion as the broader context for their procedure-specific anastomosis choices; and Colorectal Anastomotic Complications gains a pointer to this page's technique-comparison leak-rate data.

Limitations

• Textbook chapter, not primary literature; most figures (registry leak rates, mesenteric-length gains from mobilization maneuvers, PILLAR II resection-change rate) are drawn from cited studies the chapter authors summarize, not independently verified against the primary sources.
• The chapter's own stapled-vs-hand-sewn evidence review is genuinely conflicting across studies (German registry found no difference, Danish registry found stapled worse, a European multicenter study found stapled associated with higher leak risk) — preserved as unresolved here rather than adjudicated, consistent with wiki convention.
• One specific claim (splenic flexure mobilization enabling low leak rates "irrespective of anastomotic level") is explicitly sourced to the chapter's senior author's personal communication rather than a cited study — flagged as lower-strength within the new page.

Relevance

Ninth entry in the ASCRS ingest, and the first chapter since Ch5 to focus specifically on surgical technique rather than physiology, risk assessment, or complication epidemiology. Creates Anastomotic Construction and adds targeted extensions to six existing pages (Crohn Disease, Colon Cancer Resection, Low Anterior Resection Syndrome (LARS), Ileal Pouch-Anal Anastomosis (IPAA), Total Mesorectal Excision (TME) & Sphincter-Sparing Resection, Colorectal Anastomotic Complications) — the widest cross-link fan-out of any chapter in this ingest so far, reflecting how central anastomotic technique is to nearly every other procedure page.