Various types of bowel anastomosis have been described and used with satisfaction for many years. The end-to-end anastomosis is probably the most popular, but it has two distinct disadvantages. When the bowel lumen is small, it may be significantly narrowed by the diaphragm which is turned in (Fig. 1A). In addition, when there is significant disproportion between the approximated bowel ends, the unequal placement of sutures predisposes to leaking at the anastomosis.
The side-to-side anastomosis produces a large lumen with a relatively small diaphragm, but it has the disadvantage that dilatation of the blind end may occur (Fig. 1B). Furthermore, when there is marked disproportion between the bowel segments, dilatation of the larger one will sometimes compress the smaller, producing a temporary partial obstruction. However, our greatest objection to the side-to-side anastomosis is its inefficiency. It seems wasteful of time and energy to close one opening and then