A modification of the Bianchi intestinal lengthening procedure with a single anastomosis

Intestinal lengthening, as described by Bianchi, is the most commonly used method of gastrointestinal reconstruction for the therapy of short bowel syndrome. It divides the bowel in two longitudinal halves based on the bifurcated mesenteric blood supply, then reconnects the two halves in series with the rest of the small intestine. This requires three end-to-end narrow anastomoses in addition to the two longitudinal sutures lines. The authors describe a modification of the Bianchi procedure that lengthens the small intestine with a single wide end-to-end anastomosis thus avoiding two suture lines and their potential complications.

The anatomic principle used in this modification is the same as that described by Bianchi. The mesentery is separated based on the bifurcated vessels. With sequential firings of the stapler, the division of the intestine begins obliquely, proceeds longitudinally as in the Bianchi procedure, then ends obliquely at the other end of the intestine. This results in two divided segments that remain attached to the proximal and distal intestine and end in tapered staple lines. The two ends are sewn into a wide tapered anastomosis, reestablishing intestinal continuity with a single anastomosis instead of three.

This simple modification, which we have used on two patients so far, decreases the number of anastomoses in an intestinal lengthening procedure from three narrow ones to one that is wider and tapered, thus reducing the risk of leaks and strictures. Because the end result is a lengthened intestinal segment similar to the Bianchi procedure, it should be equally effective in the therapy of short bowel syndrome.