Anastomosis

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An anastomosis is a connecting duct between two anatomical structures. Only blood vessels form anastomoses with blood vessels, as do lymph vessels and nerves . Anastomoses between arteries create a bypass circuit in the event of a vessel failure, so that tissue necrosis does not occur. Arteriovenous anastomoses are important for the regulation of blood flow, but as arteriovenous malformations can have (considerable) disease value.

In surgery , surgically established connections between blood vessels, nerves and hollow organs are also referred to as anastomosis.

etymology

The word anastomosis comes from the ancient Greek ἀναστομόειν anastomóein (also: ἀναστομοῦν anastomûn ), to create a mouth ',' to open something '( ἀνά aná , German ' up ' ,' over '; στόμα stóma , German ' mouth ').,' Mouth '.

Anatomical anastomoses

There are anastomoses as connections between blood vessels (the corona mortis as an abnormally strong formation of the anastomosis between the arteria epigastrica inferior and the arteria obturatoria and the Riolan anastomosis between the intestinal arteries ), but also the arteriovenous anastomoses as connections between arteries and veins as well as anastomoses between lymphatic vessels. Nerve anastomoses are important for local anesthesia in the anterior region of the lower jaw because nerves on the other side of the jaw overlap there.

Pathological bypass circuits

Atypical anastomoses in the placental vessels are the cause of the fetofetal transfusion syndrome , which can occur in identical twins . In the case of multiple twins, these become chimeras through blood exchange . The exchange of hormones between male and female fetuses can hinder the development of the female reproductive organs.

If the portal vein is congested , blood supply to the portocaval anastomoses is increased. This can lead to dreaded esophageal varices (varicose veins in the esophagus) or, rarely, the caput medusae (belly button varicose veins ).

Surgical anastomoses

  • A vascular anastomosis is a surgically operative union of the ends of a blood vessel, for example after severing or resecting a stenosis , such as the end-to-end anastomosis in coarctation of the aorta or a lateral anastomosis after a blood vessel has been inserted into another blood vessel. The surgical connection between a natural blood vessel and a vascular prosthesis is also known as an anastomosis.
  • After resection of stomach and intestinal sections, continuity has been attempted since the Middle Ages ( Abulcasis , Ortolf von Baierland , Roger Frugardi , Heinrich von Pfalzpaint ) and in the 19th century ( Antoine Lembert , Felix-Nicholas Denans , Johann Heinrich Henroz , John B. Murphy ) made generally applicable and restored in the 20th century ( Humer Hältl , Aladár von Petz , H. Friedrich , Michael H. Vankemmel ) for viscerosynthesis further developed intestinal anastomoses . In this context , only the side -to-side connection of intestinal loops introduced around 1850 by Jacques Gilles Maisonneuve (1809–1897) was originally referred to as anastomosis or entero anastomosis . Today there are end-to-end, side-to-side, end-to-side, and side-to-end anastomoses, based on an orthograde intestinal passage. When naming, the relevant parts of the organs are always used. Accordingly, an end-to-side or Ileotransversostomie -stomose a connection between the ileum -end (after cecum resection) and the lateral wall of the colon transversum is an even more complicated example is the visceral surgical speech. Oral partial inferior terminolateral gastroduodenostomy (or - stomosis). Here, after a 2/3 gastric resection, the remaining stomach is connected at the end of the great curvature to the side wall of the duodenum, with a small curvature-side portion of the residual stomach exit being blindly sutured.
  • For the surgical repair of a severed nerve , both ends are sutured terminally in the sense of an end-to-end anastomosis. In cases where the proximal nerve end is not available or an end-to-end anastomosis is not an option for various reasons, the end-to-side anastomosis procedure can be used. In this technique, the distal stump of a severed nerve is sutured to the side of an adjacent intact nerve. The end-to-side anastomosis was used successfully by Ballance and Kennedy in patients with peripheral facial paralysis as early as the late 19th century . The technique was forgotten for almost 100 years until Fausto Viterbo again drew attention to this method in the early 1990s with experimental studies on Wistar rats .

It is important with every surgical anastomosis that it succeeds in a tight, tension-free and sufficient blood flow to the suture region, checked by means of a vascular incision close to the suture, since otherwise uncomplicated healing is called into question.

See also

literature

  • M. Bettex, N. Genton, M. Stockmann (Eds.): Pediatric Surgery. Diagnostics, indication, therapy, prognosis. 2nd Edition. Thieme, Stuttgart 1982, ISBN 3-13-338102-4 .

Individual evidence

  1. ^ W. Pschyrembel : Clinical dictionary . 265th edition. De Gruyter, 2014, ISBN 978-3-11-018534-8 .
  2. ↑ Hermann Triepel , Hermann Stieve , Robert Herrlinger , Adolf Faller: The technical terms of anatomy, histology and embryology. Derivation and pronunciation . 29th edition. JF Bergmann, Munich 1978, ISBN 3-8070-0300-2 , p. 40 ( limited preview in Google Book Search - first edition: 1906).
  3. ^ A. Blalock, HB Taussig: The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. In: JAMA. 128, 1945, pp. 189-202.
  4. ↑ Christoph Weißer: Mechanical intestinal anastomoses in surgery: A contribution to the history of abdominal surgery on the centenary of the Murphy button. In: Würzburg medical history reports. Volume 11, 1993, pp. 9-26; here: p. 9.
  5. ↑ Christoph Weißer: Gutsuture. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 286 f.
  6. ↑ Christoph Weißer (1993), p. 9.