Aim: To identify variation in main technique domains for ileocolic anastomosis
Method: Hamburg Colorectal Symposium, May 2018
Voting session with 300 senior colorectal surgeons
Likert scale of agreement
>75% taken as agreement
Two standardised scenarios
> Handsewn: Open/laparoscopic assisted
> Stapled
Areas of disagreement will be re-addressed in Delphi round 2
Delphi round 1 results:
Adequate mobilisation
Mobilisation should allow adequate access for anastomosis, with circumferential accessibility of the bowel edge of both limbs. 91% Agree
Configuration
A side to side configuration for ileocolic anastomosis should be used in most cases.
58% Agree
An end to side configuration for ileocolic anastomosis should be used in most cases.
14% Agree
The size of the enterotomy should be at least the transverse diameter of the patient’s small bowel.
76% Agree
Hand Sewn Anastomosis
In healthy bowel, a continuous suture is acceptable
90% Agree
In diseased bowel, interrupted sutures are recommended
43% Agree
The suture gauge used should be 3-0 or 4-0
84% Agree
The suture used should be an absorbable
96% Agree
The suture used should be monofilament
61% Agree
The smaller the ‘bites’, the smaller the distance should be between ‘bites’.
66% Agree
The minimum depth of each suture bite should be at least 3mm of seromuscular layer.
85% Agree
Stapled anastomosis
Bowel should be aligned in a side-to-side configuration.
93% Agree
A minimum of 15 seconds of tissue compression is needed prior to firing.
89% Agree
The apical staple line should only be oversewn if there are specific concerns (e.g. staple line incomplete, bleeding).
59% Agree