Primary anastomosis is a surgical procedure which may be used to reconnect sections of the large intestine following the removal of diseased tissue. Anastomosis in general is the reconnection of two flowing streams. In a surgical context, a primary anastomosis is the reconnection of two sections of an organ following the excision of diseased tissue. The procedure can be used following sectioning of the urinary tract (urethra) or throat (oesophagus), but is seen most frequently in bowel surgery.
The large and small intestines (bowels) connect the stomach to the anus. The colon is part of the large intestine. A number of medical conditions can adversely affect the functioning of the bowels and general health. Diverticulitis is an inflammation of bulges which can occur in the large intestine, and in serious cases may cause a breach in the intestinal wall and painful leakage into the abdomen. Ulcerative colitis is an inflammation of the lining of the large intestine. Crohn's Disease is an inflammatory condition that can affect all layers of both the small and large intestines. Colon cancer is the development of malignant cells in the large intestine. All these conditions might indicate the need for a colectomy.
The Colectomy Procedure
A colectomy is a surgical intervention designed to remove inflamed, cancerous or otherwise pathological tissue from the large intestine. Occasionally surgeons are compelled to perform a total colectomy, removing the large intestine in its entirety. More commonly, a colectomy involves the removal only of the diseased section of the bowel, leaving the remainder intact. Colectomies can be performed through an incision in the abdominal wall, or in some cases through minimally invasive small incisions (laparoscopy).
The Colostomy Option
Once the diseased portion of the intestine is removed, the function of the remaining parts needs to be restored. One option for restoring bowel function is performing a colostomy. In a colostomy, the functioning section of the intestine (the end descending from the stomach) is connected to the surface of the abdomen. The remaining section descending to the abdomen can be excised or closed. The attachment of a colostomy bag to the newly created intestinal opening allows the collection of faeces.
The Primary Anastomosis Procedure
A colostomy may be a temporary measure, but can be distressing, socially embarrassing and significantly reduce the patient's quality of life. The alternative is to perform a primary anastomosis, surgically reconnecting the remaining parts of the intestine with sutures or staples. One advantage of primary anastomosis in cases where a colostomy is likely to be temporary is avoiding the trauma and cost of a second operation to reverse the colostomy. The main risk of primary anastomosis is that the reconnection may break down, leading to leakage into the abdominal cavity and infection. A secondary anastomosis refers to a later operation to attempt a reconnective procedure.
A Difficult Choice
While primary anastomosis after a colectomy carries a risk of breakdown, infection and even death, the benefit is the restoration of the bowel as an entire and functioning organ. A colostomy, if permanent, can be a source of ongoing discomfort and embarrassment. In some circumstances, and especially if an emergency colectomy is performed, the patient may have no choice, and at least a temporary colostomy may be the outcome. Where surgery is planned, a difficult choice must be made.