Half-Halsted suturing technique for anastomosis on edematous bowel

Background

Bowel anastomoses are prone to dehiscence or leakage under various circumstances, including that of the small and large bowel parts being not completely healthy. The edematous or hypertrophic bowel ends that are left after excision or removal of an obstacle, are either exteriorized, or, with increased risk of leakage, sutured or anastomosed.

Methods

During the period 1/2014-8/2017, the half-Halsted suturing technique was used in the construction of intestinal anastomoses on edematous and/or hypertrophic small and large bowel in 35 patients (19 males, 16 females) with a mean age of 58 years and ASA status II-III. Of these, 22 patients were suffering from malignant and 13 from benign disease. Emergency surgery was performed in 19, and the rest had semi-emergency (2) or elective (14) surgery. All the cases were characterized by bowel wall ends that were not totally normal after excision or removal of an obstacle, while in 30 patients one or both of the bowel ends to be anastomosed presented significant edema or hypertrophy. The anastomoses that were constructed connected small to small bowel (21 patients), small to large bowel (11) or large to large bowel (3). Anastomoses were fashioned either end-to-end (19 patients), side-to-side (10) or end-to-side (6).

Results

No death occurred in this series, and no anastomotic leak, bleeding or abscess developed. Minimal complications (non-anastomosis related) developed post-operatively in 10 patients. The mean postoperative hospitalization was 8.2 days.

Conclusions

The half-Halsted suturing technique is safe and effective for anastomoses of edematous or hypertrophic small and large bowel.