Background: While tension on anastomoses is largely regarded as a key factor in anastomotic leaks and failure, the assessment of this tension is based on subjective surgeon estimation. There is currently no clinically available tool to objectively assess mechanical tension on an anastomosis. Some animal and human studies have previously assessed anastomotic tension, but no comprehensive review exists that discusses the different methods and types of tension measured. Objectives: To summarize the current state of literature regarding measurement and impact of tension on bowel anastomoses. Findings: Anastomotic leak and tension have been found to be strongly associated, with the presence of tension making leak 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. Literature describes several techniques to allow adequate mobilization such as splenic flexure mobilization or division of the omentum, but 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. Conclusions: Objective measurement of bowel tension in live human subjects has not been studied in the current literature. Bowel mobilization is a common method to reduce tension, but it relies on subjective judgment and 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.

The authors have declared no competing interest.

This study did not receive any funding

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