**2. General aspects of bowel anastomoses and modern variations that impacted the outcome**

Barbed sutures are available in a variety of both absorbable and nonabsorbable monofilament materials. Specifically, currently available bidirectional and unidirectional barbed suture materials include PDO, polyglyconate, poliglecaprone 25, glycomer 631, nylon, and polypropylene. A study performed by Wiggins [1]

#### **Figure 1.** *Intraoperative aspect of an anastomosis performed manually at the level of the small bowel.*

**Figure 2.** *Intraoperative aspect of an anastomosis performed mechanically at the level of the small bowel.*

searched through a systematic review and meta-analysis for the benefits of barbed suture utilization in gastrointestinal anastomosis. The conclusion was that the use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding, or stricture) compared with standard suture materials.

The study included consecutive CD patients with ileal/ileocolonic strictures who had SWE shear wave elastography within one week of surgical resection.

The SWE of the stenotic bowel wall was compared to the biofragmentable anastomosis ring used for gastrointestinal anastomoses in a literature review conducted by Bobkiewicz and coauthors [2].

The theoretical idea was that a biofragmentable anastomosis ring (BAR) could be used instead of manual and stapled anastomoses in the upper and lower GI tracts.

The aim of this study was to see how effective BAR was for bowel anastomoses using our own content. Methodologies: Between 2004 and 2014, a retrospective study was conducted on a total of 203 patients who underwent bowel surgery with *The Problem of the Colorectal Anastomosis DOI: http://dx.doi.org/10.5772/intechopen.100302*

**Figure 3.** *Foreign body reaction at the level of the tissues containing suture material.*

**Figure 4.** *Colorful surgical nylon monofilament suture with a curved needle.*

BAR anastomosis in the upper and lower gastrointestinal tract. The study concluded that using BAR for GI tract anastomoses is an easy and quick procedure with a low rate of perioperative mortality (0.5%) and complication rates (**Figures 3** and **4**).
