The art of bowel anastomosis.

Anastomotic techniques have greatly improved over the past two centuries, and postoperative complications have fallen accordingly. Factors contributing to anastomotic failure include location and systemic diseases such as sepsis and hemorrhagic shock. Factors that have not demonstrated any difference in outcome include stapled versus hand sewn anastomosis, continuous versus interrupted sutures, and single versus two layer anastomosis. Successful intestinal anastomosis necessitate adequate exposure and access, gentle tissue handling, absence of tension and distal obstruction, hemodynamic stability with adequte tissue oxygenation, and meticulous surgical technique.