Impact and Assessment of Mechanical Tension in Bowel Anastomosis: a Scoping Review
Bibliographic record
Abstract
Abstract Background While tension on anastomoses is primarily regarded as a critical factor in anastomotic leaks and failure, assessing this tension is based on subjective surgeon estimation. There is currently no clinically available tool to assess mechanical tension on an anastomosis objectively. Some animal and human studies have previously evaluated anastomotic tension, but no comprehensive review discusses the different methods and types of tension measured. Objectives To summarize the current state of the literature regarding the measurement and impact of tension on bowel anastomoses. Design This scoping review was conducted with a systematic search of literature in the PubMed, SCOPUS, and EMBASE databases. Key terms used were anastomoses/anastomosis, tension, bowel, surgery, intestine, tissue, small bowel, large bowel, bowel, mucosal tissue, and other corollary terms. Data were synthesized in tables, and summarized paragraphically, with studies assessed using the New-Castle Ottawa scale where possible. Emphasis was placed on method of tension assessment, outcomes, and factors relating to tension. Results Anastomotic leak and tension are strongly associated, with the presence of tension making leaks up to 10 times more likely. While freedom from tension has traditionally been measured via the surrogate measure of adequate bowel mobilization, this remains a subjective and imprecise method. The literature describes several techniques to allow adequate mobilization, such as splenic flexure mobilization or division of the omentum. However, basing the estimate of tension on subjective assessment has some inherent drawbacks. Animal and cadaveric studies have been the frontier for objective measurement of wall tension, with the use of scaffolds, suture types, and prostheses to bolster the natural tolerance of the bowel. However, these tend to use tensiometers to measure tension, along with automated machines or pulley and ratcheting systems to increase tension in specified intervals. These are universally destructive due to their design of measuring maximal tensile load as well as not being easily adaptable to the operating room. Conclusions The current literature does not study objective measurement of bowel tension in live human subjects. Bowel mobilization is a common method to reduce tension, but it relies on subjective judgment, which varies between surgeons. Given the recognized importance of tension, developing an objective, safe, intra-operative method to measure bowel wall tension would be a valuable surgical tool.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.099 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.007 |
| Bibliometrics | 0.028 | 0.023 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.005 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".