In many instances, it makes more sense to do an end-to-end anastomosis rather than side-to-side - especially in the large bowel. Here is a technique to create an end-to-end anastomosis using three loads of a TA stapler.
This free PDF is available online - Scroll down to page 9
Does this reduce the bowel lumen?
If you consider a segment of the bowel with a diameter of 2 inches (radius 1 inch), the area of the circle will be 3.14 inches^2, and the perimeter will be 6.2 cm.
Therefore, starting area = 3.14 inch^2
When the anastomosis is converted to an equilateral triangle of 6.2 cm perimeter, the area will be The area of an equilateral triangle can be calculated using the formula:
A = (s^2 * √3) / 4
Where s is the length of a side of the triangle. To find the side length, we need to use the perimeter of the triangle:
P = 3s
So s = P / 3 = 6.2 inches / 3 = 2.067 inches
Now we can use this value of s to find the area of the triangle:
A = (2.067^2 * √3) / 4 = (4.277 * √3) / 4 = 2.132 inches^2
So the area of an equilateral triangle with a perimeter of 6.2 inches is approximately 2.132 square inches.
Therefore, the lumen is narrowed by 37%. So I would not recommend using this approach on the small bowel.
Surgical Video demonstrating the technique.
The patient is a 67-year-old with endometrioid endometrial cancer with isolated recurrence involving the descending colon right below the splenic flexure.
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