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Views: 0 Author: Weiyuan Content Editor Publish Time: 2026-04-03 Origin: Weiyuan Original
With the development of minimally invasive surgery, intestinal anastomosis has evolved from traditional hand-sewn techniques to a variety of device-assisted methods. Nowadays, surgeons can choose from end-to-end, side-to-side, functional end-to-end (FEEA), and Overlap anastomosis techniques. Each method has its own indications, technical features, and clinical pros and cons. Here’s a straightforward overview of how these anastomoses are performed, along with their key points and considerations.
FEEA Anastomosis
FEEA, or Functional End-to-End Anastomosis, usually uses a circular stapler (like an EEA stapler) to perform end-to-end, end-to-side, or functional end-to-end anastomoses. The basic steps are: first, transect the proximal bowel, then insert the proximal end into the stapler anvil with the suture. About 2 cm from the intended resection line, penetrate the bowel wall and secure it with sutures. Close the proximal bowel with the stapler, then pull the anvil with the spike out of the bowel. The specimen can also be retrieved through the anus. Finally, close the distal stapler to complete the colonic end-to-end anastomosis.
Side-to-Side Anastomosis
Clinically, there are three common types of side-to-side anastomosis: isoperistaltic, antiperistaltic, and Overlap.
Isoperistaltic Anastomosis
The anastomosis is aligned with the bowel’s natural peristalsis. First, transect the proximal and distal bowel with a stapler, then bring the two ends together and pull toward the left upper abdomen. Create small openings on the antimesenteric sides of each bowel segment, insert the linear stapler into both lumens, and complete a side-to-side colonic anastomosis. Finally, close the common opening with continuous absorbable sutures.
Antiperistaltic Anastomosis
Here, the anastomosis is against the direction of bowel peristalsis. The steps are similar to isoperistaltic, but the bowel ends are brought to the midline. Open the antimesenteric side of the bowel ends, insert the linear stapler, and perform the side-to-side anastomosis. Close the common opening with 2–3 interrupted sutures, then lift the sutures and use the stapler perpendicular to the mesentery to fully close the opening.
Overlap Anastomosis
This is a special type of side-to-side anastomosis that overlaps two bowel segments using a linear stapler. Open the bowel at the proximal end and about 6 cm from the distal end. Insert the two arms of the linear stapler into the lumens of the distal and proximal segments from the tail side, pull the mesentery to overlap the segments so the bowel walls align, and fire the stapler to complete the anastomosis.
End-to-End Anastomosis
End-to-end anastomosis is a more traditional approach. Some steps in FEEA overlap with this method. It was widely used in the era of hand-sewn anastomoses, especially in the small intestine. One thing to keep in mind: end-to-end anastomoses are more prone to narrowing at the anastomotic site.
Circular Stapler price
The price of a circular stapler really depends on a few things—brand, model, size, and where you’re buying it. Big-name international brands like Ethicon usually go for around $250 to $600 a piece, depending on the staple size, diameter, and whether it comes with a surgical kit. If you’re looking at domestic or more budget-friendly options, you’re usually talking $100 to $250. Bigger staplers or special models tend to cost a bit more. And of course, how you buy it matters too—bulk hospital orders or tender purchases usually bring the price down, while buying just one for a small clinic or single use can be a bit pricier. Bottom line: circular staplers usually fall somewhere between $100 and $600, and brand, size, and purchase method are the biggest factors.
