Stapled side-by-side bowel anastomosis

Side-to-side stapled reconstructions start with sharply removing a portion of the staple line near the antimesenteric border if a stapler was used to transect the bowel (A). The gastrointestinal anastomosis (GIA) stapler is then introduced into each end of the bowel and aligned by the antimesenteric border (B). The stapler is closed and inspected to ensure that no other intra-abdominal contents have been inadvertently caught. The stapler is then fired and removed, and the newly created common channel inspected for hemostasis with ring forceps. A transverse anastomosis (TA) stapler is typically used to close the common enterotomies (C). Allis clamps are used to align the common enterotomy in the TA stapler with the linear staple lines offset (E). The completed anastomosis has the TA staple line intersecting with two GIA staple lines on the outside, and a GIA staple internally (D). Finally, a reinforcing silk "crotch" stich may be placed at the distal end of the anastomosis as this area is subject to the most tension.