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2022-RA-272-ESGO ‘Double O’ technique of bowel anastomosis
  1. TS Shylasree1,
  2. Pabashi Poddar2 and
  3. Manish Bhandare2
  1. 1Gynecological Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
  2. 2Tata Memorial Hospital, Mumbai, India


Introduction/Background Bowel resection and anastomosis is an integral part of subspeciality training in gynecological Oncology. The principles of bowel surgery are not only to remove cancer to achieve optimal debulking but also to reduce leak rate and postoperative morbidity. Reduction in leak rate is achieved by good technique and adequate training. In hand held anastomosis, proper suturing of the corners of the bowel is considered crucial to reduce leak rate. We hereby present a surgical video demonstrating a novel technique of hand sewn ileo-ileal anastomosis in a lady undergoing debulking surgery for ovarian cancer.

Methodology A 53-year-old lady with stage IIIc high grade serous ovarian carcinoma underwent total hysterectomy, bilateral adnexectomy, peritonectomy, omentectomy and resection anastomosis of the involved ileal bowel segment. The novel technique used is a double layered closure of the enterotomy in continuous circular fashion, thus eliminating the perception of corner while suturing. Two delayed absorbable sutures with double ended needle are used for the technique.

Results Patient had optimal debulking surgery and the postoperative course was uneventful. She received adjuvant chemotherapy and is disease free for 24 months.

Conclusion Surgical skill development is crucial for reducing postoperative morbidity and to achieve optimal debulking. Due to increased use of staplers for bowel anastomosis in recent decades, hand sewn bowel anastomosis is not practiced regularly. However, hand sewn anastomosis is cost effective and is especially useful in resource limited or emergency setting. ‘Double O’ technique is simpler to use and eliminates many technical nuances described in traditional hand-sewn anastomosis. The technique helps the gynecological oncology surgical trainee to learn and retain the steps due to its simplicity and also helps to overcome the fear of suturing corners in bowel anastomosis during the learning curve.

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