Updates in Surgery

, Volume 65, Issue 4, pp 333–335 | Cite as

Autobuttressing of colorectal anastomoses using a mesenteric flap

  • H. M. Mohan
  • D. C. Winter
Technical Note


Anastomotic leakage is a common and dreaded complication of colorectal surgery. Many different approaches have been tried to attempt to reduce leakage and associated morbidity. The concept of reinforcement of an anastomosis by buttressing is well established. Techniques described include using sutures, native omentum, animal or synthetic material. We report a technique for buttressing using a mesenteric flap to envelope the anastomosis. The primary rationale is to reduce clinical sequelae of anastomotic leakage by promoting local containment, as well as providing a scaffold for healing. Using autologous tissue provides a safe, time-efficient and cost-effective buttress without the risks of infection or reaction associated with foreign material. A mesenteric flap is particularly useful in patients in whom omentum is not available due to previous surgery, or to fill the dead space posterior to a low anastomosis within the pelvis.


Anastomoses Mesenteric flap Buttressing Anastomotic leak 



The authors acknowledge the assistance of Paul Quinlan, Medical Illustrations Unit, Trinity College Dublin, Ireland, with the illustrations in this paper.

Conflict of interest



  1. 1.
    Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 148(1):65–71PubMedCrossRefGoogle Scholar
  2. 2.
    Manilich E, Vogel JD, Kiran RP et al (2013) Key factors associated with postoperative complications in patients undergoing colorectal surgery. Dis Colon Rectum 56(1):64–71PubMedCrossRefGoogle Scholar
  3. 3.
    Neutzling CB, Lustosa SA, Proenca IM et al (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2:CD003144Google Scholar
  4. 4.
    Gaertner WB, Hagerman GF, Potter MJ et al (2010) Experimental evaluation of a bovine pericardium-derived collagen matrix buttress in ileocolic and colon anastomoses. J Biomed Mater Res B Appl Biomater 92(1):48–54PubMedGoogle Scholar
  5. 5.
    Mery CM, Shafi BM, Binyamin G et al (2008) Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure. Surg Obes Relat Dis 4(3):416–422PubMedCrossRefGoogle Scholar
  6. 6.
    Ho YH, Ashour MA (2010) Techniques for colorectal anastomosis. World J Gastroenterol 16(13):1610–1621PubMedCrossRefGoogle Scholar
  7. 7.
    Collins D, Hogan AM, O’Shea D et al (2009) The omentum: anatomical, metabolic, and surgical aspects. J Gastrointest Surg 13(6):1138–1146PubMedCrossRefGoogle Scholar
  8. 8.
    Goto T, Kawasaki K, Fujino Y et al (2007) Evaluation of the mechanical strength and patency of functional end-to-end anastomoses. Surg Endosc 21(9):1508–1511PubMedCrossRefGoogle Scholar
  9. 9.
    Malcynski JT, Shorter NA, Mooney DP (1994) The proximal mesenteric flap: a method for closing large mesenteric defects in jejunal atresia. J Pediatr Surg 29(12):1607–1608PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  1. 1.Department of SurgerySt. Vincent’s University HospitalDublin 4Ireland

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