Editing Anastomosis (section)

=== '''Functional     end-to-end extracorporeal''' ===

** Ask for - 2x soft bowel      clamps, GIA 80 blue stapler with one reload available; other stuff should      be on set-up already.
** Divide mesentery between the      two points where you will be inserting the stapler
*** Ligasure/Harmonic - score       mesentery then directly across, double burning
*** Ties - score mesentery with       diathermy; thin out a window 2 inches away between two fingers; clamp       above and below with Roberts forceps; cut across with scissors
** Downstream soft bowel clamps      - one click
** Protect the wound with packs
** Position the bowel so that      anti-mesenteric borders are in apposition
*** Optional - suture near the       planned enterotomies to hold the bowel in apposition, if having trouble       keeping it still
** Create small enterotomies at      the anti-mesenteric edge with cutting diathermy and insert a linear      cutting stapler (usually blue GIA 80). Check mesentery is free at each      end. Be sure to support the bowel well, so it doesn't get any tension      from the weight of the staplers.
** Fire the stapler
** Remove the stapler and apply      Babcock clamps to two lips of the enterotomy, offsetting the opposing      staple lines. Check for intra-luminal bleeding, and oversew if with 3/0      PDS if needed.
** Close the defect by firing a      new stapler cartridge transversely across the top
*** Haemostasis by very       conservative diathermy or interrupted PDS figure-of-eight
*** Underrun the staple line       with 3/0 PDS continuous, and consider inverting/imbricating the ends of       the staple line
** Crotch suture x2
** Close the mesenteric defect      with interrupted 3/0 PDS
** Cover the anastomosis with      omentum if feasible