Bowel anastomosis in acute care surgery

Purpose of Review Acute care surgery encompasses the disciplines of trauma, emergency general surgery, and surgical critical care. Inherent in the disease processes of trauma and emergency general surgery is the potential for profound physiologic and anatomic derangements that make the decision to create an intestinal anastomosis, as well as the technique used, a vital step in having a suc-cessful outcome for the patient. Recent Findings The trauma literature is rife with conflicting data regarding ideal techniques for anastomosis creation. Two series by Brundage and colleagues suggest that handsewn techniques are superior, which was then contradicted by Witzke et al. Vasopressor usage and blood transfusion appear to put the patient at higher risk for anastomotic failure, as does the utilization of damage control techniques. The emergency general surgery literature is similarly contradicting, with one large retrospective study suggesting handsewn techniques to be superior and a subsequent prospective multicenter study suggesting no difference. Damage control patients do appear to have higher anastomotic failure rates, with the noted absence of good data regarding colorectal resections and ideal management strategies. Summary With the conflicting messages throughout the literature, the acute care surgeon must utilize sound surgical principles and techniques when deciding to per-form an anastomosis and choosing a technique to utilize.