Abstract:
A method and instruments used to performing an end-to-end anastomosis between two portions of intestinal tissue is disclosed. The method involves drawing a first portion of intestinal tissue over a portion of a bioabsorbable stent. The end of the first portion of intestinal tissue is everted on the stent to create a collar of exposed inner intestinal tissue. A second portion of intestinal tissue is drawn over the stent and over the exposed intestinal tissue. A bandage containing one adhesive compound selected from the group of an adhesive and an adhesive initiator is wrapped about the juncture. The other adhesive compound is applied to saturate the bandage and the combination of an adhesive and an adhesive initiator sets the adhesive to adhere the first portion and the second portion of adhesive to the bandage.

Description:
FIELD OF THE INVENTION 
       [0001]    The present invention relates, in general, to surgical devices and methods for performing an end to end anastomosis of intestinal or bowel tissue, and more particularly to methods of using an adhesive and a stent to perform the anastomosis. 
       BACKGROUND OF THE INVENTION 
       [0002]    Reconnection of two tubular structures (e.g. colon to colon or even colon to stomach) has been a tedious and difficult task. Because of the nature of the material that passes within the colon, contamination containment and leakage prevention are desired. To this end circular staplers have been adopted as a means to quickly reconnect these ends of the colon with one or more concentric rings of staples. Often however the surgeon goes though many steps to insure that there are no leaks in this reconnection. It is not uncommon for dye to be placed into the colon to indicate leaks, or, using pressurized saline to pressure test the staple lines for leaks. If a leak is found, over-sewing the region is a common solution. 
         [0003]    Thus, a challenge in joining two pieces of intestinal tissue together in a surgery such as a Duodenojejunostomy, is the reconnection of the two tubular intestinal structures in a leak-proof manner. And if a leak is found, being able to quickly, simply, and easily patch the leak. 
         [0004]    Other devices such as stents are used to align and bring together luminal structures such as the intestine. Unlike the rigid stents, intestinal structures are dynamic and use peristalsis to constrict and move intestinal contents. The use of a stent in combination with a material and an adhesive are known such as that taught in U.S. Pat. No. 5,254,113 by Peter Wilk, which is hereby incorporated by reference in its entirety. The collagen based material used by Wilk offers adhesive advantages when used with laser welding but is not porous. Many types of adhesives address the needs of surgery such as adhesives and adhesive initiators disclosed in U.S. Application 20040190975 by Goodman et al. which is hereby incorporated by reference in its entirety. 
         [0005]    Consequently, a significant need exists for a method of quickly and easily joining two portions of intestinal tissue together in an end-to-end anastomosis that overcomes the deficiencies of the previous methods, reduces surgical time, offers advantages not available with previous devices and methods, and can restore natural body functions at the surgical site. 
       BRIEF SUMMARY OF THE INVENTION 
       [0006]    The invention overcomes the above-noted and other deficiencies of the prior art by providing a method of creating an end-to-end anastomosis between a first portion of intestinal tissue and a second portion of intestinal tissue. The method comprises a first step of providing a biodegradable stent and a second step of drawing the first and second portions of intestinal tissue together in end-to-end contact over the biodegradable stent. The third step is to wrap the first portion and the second portion of intestinal tissue with a bandage containing an adhesive compound. The adhesive compound is selected from the group of an adhesive and an adhesive initiator. The fourth step is to secure the first portion and the second portion of intestinal tissue together in an anastomosis by saturating the bandage with the other of the adhesive compounds to initiate adhesion of the first portion of intestinal tissue and the second portion of intestinal tissue to the bandage. 
         [0007]    In another aspect of the invention, a second method of creating an end-to-end anastomosis between a first and a second portion of intestinal tissue is provided. The method comprises the first step of providing an expandable biodegradable stent and a second step of expanding the stent in at least one of the first and second portions of intestinal tissue. The third step is to evert an end of one of the first and second portions of intestinal tissue on the expanded stent. The fourth step is drawing the end of the other of the first and second portions of intestinal tissue over the everted end to create an overlapping joint. The fifth step is wrapping the overlapping joint with a bandage containing a compound selected from the group of an adhesive and an adhesive initiator. And, the last step is securing the first portion and the second portion of intestinal tissue together in an anastomosis by saturating the bandage with the other compound. The other compound initiates adhesion of the first portion of intestinal tissue and the second portion of intestinal tissue to the bandage. 
         [0008]    In yet another aspect of the invention, a third method of creating an end-to-end anastomosis between a first and a second portion of intestinal tissue is provided. The method comprises a first step of providing a stent made from a bioabsorbable material and a second step of drawing the first and second portions of intestinal tissue into end-to-end contact about the stent. The third step is wrapping the first portion and the second portion of intestinal tissue with a bandage made from a bioabsorbable material and containing a bioabsorbable adhesive compound. The bioabsorbable adhesive compound is selected from the group of an adhesive and an adhesive initiator. The last step is securing the first portion and the second portion of intestinal tissue together in an anastomosis by saturating the bioabsorbable bandage with the other of the bioabsorbable adhesive compounds. The other of the bioabsorbable adhesive compounds adheres the first portion of intestinal tissue and the second portion of intestinal tissue to the bioabsorbable bandage. 
         [0009]    These and other objects and advantages of the present invention shall be made apparent from the accompanying drawings and the description thereof. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0010]    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention. 
           [0011]      FIG. 1  is an isometric view of the elements of an anastomosis device for performing an intestinal anastomosis. 
           [0012]      FIG. 2  is an isometric view of a portion of the anastomosis device of  FIG. 1  shown extending from a first portion of intestine with an unexpanded stent on an inflatable deployment device. 
           [0013]      FIG. 3  is an isometric view of the portion of the anastomosis device of  FIG. 2  shown extending from a first portion of intestine with the inflatable deployment device partially inflated to partially expand the stent. 
           [0014]      FIG. 4  is an isometric view of the portion of the anastomosis device of  FIG. 3  shown extending from a first portion of intestine with the inflatable deployment device fully inflated to fully expand the stent. 
           [0015]      FIG. 5  is a side cross sectional view showing the fully expanded stent partially within the first portion of intestine after the inflatable deployment device has been deflated and removed, and showing a lip of the first portion of intestine everted over on itself. 
           [0016]      FIG. 6  is a side cross sectional view of  FIG. 5  showing a grasper pulling a second portion of intestine onto the fully expanded stent and over the everted lip of the first portion of intestine. 
           [0017]      FIG. 7  is a side cross sectional view of  FIG. 6  showing a layer of adhesive saturated material placed around the overlapping joint of the first portion and second portion of intestine. 
           [0018]      FIG. 8  is an isometric view of the completed anastomosis of the first portion and second portion of intestine with the inner layers in contact to ensure tissue growth, and with the adhesive saturated material creating a leak proof joint between the intestinal portions. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0019]    The following description of certain examples of the invention should not be used to limit the scope of the present invention. Other examples, features, aspects, embodiments, and advantages of the invention will become apparent to those skilled in the art from the following description, which is by way of illustration, one of the best modes contemplated for carrying out the invention. As will be realized, the invention is capable of other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive. 
         [0020]    Turning to the figures, wherein like numerals denote like components throughout the several views, in  FIG. 1 , an anastomosis device  25  is shown for the end-to-end anastomosis or splicing of two pieces of luminal tissue such as intestinal or bowel tissue. The anastomosis  25  device comprises a stent placement device  30  to place an expandable stent  40  within the of two pieces of luminal tissue, an absorbable material or bandage  50  to wrap around the two pieces of luminal tissue when they are brought into contact over the stent, and a fluid dispenser  60  that for this example, can place a fluid  61  or adhesive  62  onto the bandage  50  to adhere tissue to the bandage. Depending on examples cited below, fluid dispenser  60  can contain a variety of fluids  61  such as an adhesive  62  or an adhesive initiator  65 , and can include an additive  64  in combination therewith. 
         [0021]    The stent placement device  30  has a distal inflatable deployment device  31  with an unexpanded stent  40  thereon for insertion into luminal tissue of a patient. The inflatable deployment device  31  comprises a stent expander such as a balloon  32  that is operably attached to a hollow catheter  33  to expand the stent  40  within luminal tissue. A number of devices can expand the stent  40  but for this example, the stent expander is the balloon  32  which can be inflated with a fluid such as a compressable fluid like air, or a non-compressable fluid like water or saline. Hollow catheter  33  extends proximally from the deployment device  31  and operably connects to a proximal pump assembly  34  that pumps fluids therethrough. 
         [0022]    Pump assembly  34  can be single stroke or multi-stroke to reduce pumping forces, and has a check valve assembly  35  at a distal end operably coupling the pump assembly  34  to the hollow catheter  33 . Check valve assembly  35  allows comprises a first check valve (not shown) operably coupling pump assembly  34  to catheter  33 , and a second check valve (not shown) operably coupled to the orifice  36 . Check valves are well known to those skilled in the art, and open to allow one way fluid flow through the check valve, and close to prevent flow in the opposite direction. Check valves can be as simple as a ball and spring, or a deflectable diaphragm or a reed valve. Upon a suction stroke of plunger  38 , the check valve assembly  35  allows pump assembly  34  to draw air through orifice  36 , past the second check valve, and into a chamber  37 , while the first check valve blocks the catheter  33 . A compression stroke of plunger  38  closes the second check valve and orifice  36 , and opens the first check valve to the hollow catheter  33 , enabling fluid to be forced past the valve assembly  34 , into the hollow catheter, and into the balloon  32 . As plunger  38  moves back for the next suction stroke, the first check valve assembly  35  once again closes off the catheter  33  during the intake stroke to seal the compressed air in the hollow catheter  33  and in the partially inflated balloon  32 , and the second check valve opens to draw fluid into the orifice  36  and chamber  37  for the next pressurization stroke. Thus, multiple strokes of the plunger  38  can be used to fully inflate balloon  32  with lower actuation force. 
         [0023]    A normally closed rotary release valve  39  is provided on one way valve assembly  35  and when opened, opens a venting passageway  36   a  (on farside of  FIG. 1 , not shown) between catheter  33  and the atmosphere to vent or release the fluid within the hollow catheter  33  and inflated balloon  32 . The release of fluid back to atmospheric pressure deflates balloon  32 . Alternately, by way of example, another fluid such as saline can be used to inflate the balloon  32 . Attachment of a saline line to the orifice  36  would enable the saline to be drawn into the pump assembly  34  to accomplish this. Attachment of a vacuum line to venting passageway  36   a  would draw fluid from and collapse the expanded balloon  32  for easier withdrawal from the expanded stent  40   
         [0024]    The anastomosis device  25  also includes a porous or absorbable bandage  50  that can be wrapped around tissue such as luminal tissue, and the fluid dispenser  60  to apply fluid  61  to the bandage  50 . For this example fluid  51  is an adhesive  62  that can wick into the bandage  50  and adhere the bandage to luminal tissue. Fluid  51  is sealed in fluid dispenser  60  and can be released by breaking and removing cap  63 . 
       The Stent 
       [0025]    The stent  40  is an open tubular shape made from wires or mesh that is expandable from a small diameter cylindrical shape of  FIG. 1  to a larger diameter cylindrical shape as shown in  FIGS. 3-7 . Stents are well known in the cardiovascular art for their initial small size when inserted, ease of use, and ability to create an expanded structure that can hold open blocked luminal structures such as arteries and veins. Stents are also used to hold open lumens in other areas of the body such as the urethra, and the billiary duct. For this invention, the stent  40  can be used to join and hold open two sections of intestine or bowel. 
         [0026]    Like the cardiovascular stents, the intestinal stent  40  can be made from any one of a number of materials and can be expanded in a number of ways. The stent  40  must exhibit strength and size characteristics permitting it to be used for intestinal applications. As shown, the stent  40  is made from a tubular metallic structure that has material removed by chemical processes such as photoengraving, or by energy processes such as laser or EDM ablation or cutting. Suitable metallic materials include but are not limited to titanium, phase change alloys such as NITINOL (nickel titanium alloy Naval Ordinance Lab), tantalum, gold, and the like. For this example, the stent  40  is made from a malleable grade of titanium (dead soft) that can be expanded and work hardened by the balloon  39 . This example is merely exemplary and other types of materials, tempers, treatments, stent expanders and the like are encompassed by the spirit of the invention. For example, rather than a dead soft material, stent  40  can be constructed from but not limited to a spring material, a polymeric material, a shape memory alloy, or superelastic alloy. 
         [0027]    Each of the examples conform to the spirit of the invention and can require a different stent expander or mechanism suited to enable the stent  40  to expand. By way of example, if stent  40  is constructed from spring materials, the spring properties of the stent itself can expand the stent and the stent expander is a constraint system to hold the stent in an unexpanded position until released. Also by way of example, if the stent is constructed from polymeric materials, the balloon can be the stent expander. And, by way of example, if the stent  40  is constructed from a shape memory alloy, the stent expander can be a heater to cause the expansional phase change, or the shape memory alloy itself which is carefully formulated to undergo an expansive phase change when subjected to body temperatures. Additionally, a balloon stent expander or wedge expander can be used to expand a superelastic stent. 
         [0028]    Alternately, stent  40  may be made from any one of a number of suitable biocompatible non-elastomeric materials, such as metal wire, stiff polymeric strands, carbon, ceramic materials, biodegradable materials, or combinations thereof. Metals can also include stainless steel. Of the metals that may be used, titanium or tantalum offer radiopacity and overall flexibility which is characteristic of the low modulus of elasticity of these types of materials. Polymeric materials can include polyesters (such as Dacron) and polyglycolic and polylactic acid (Vicryl). 
         [0029]    The stents can be non-absorbable or absorbable by the body. The metallic stents remain within the patient&#39;s body for the life of the patient. Absorbable polymeric materials, could be used by the present invention such as but not limited to, polylactic acid (PLA), polyglycolic acid (PGA) and their copolymers, dexon, vicryl, polydioxanone, and polyglyconate. These materials would be absorbed by the body after healing has taken place. Stents are well known in the medical arts, and descriptions of stents, manufacturing processes, and materials can be found in U.S. Pat. No. 5,015,253 to D. MacGregor entitled “Non-Woven Prosthesis” and in U.S. Pat. No. 5,843,176 by S. Weier entitled “Self Expanding Endo-Prosthesis” both of which are hereby incorporated by reference in their entirety. 
       The Bandage 
       [0030]    The bandage  50  is used to wrap around the intestinal splice and to wick up or absorb and hold the adhesive  62  in place. The bandage  50  is biocompatible and may be one or more layers of a porous structure such as a gauze, an open cell foam, a mesh, or any porous structure. Bandage  50  could be constructed from bioabsorbable or biodegradable materials such as polylactic acid, polyglycolic acid, polyglactin, polydioxanone, and polyglyconate. Additionally, by way of example, bandage  50  can be constructed from non-absorbable materials such as but are not limited to metallic materials such as stainless steel, titanium, and gold, and to non-metallic materials such as silk, nylon, polypropylene, braided polyester, polybutester, polyethylene, and polyetheretherketones (PEEK). Bandage  50  could be constructed as an absorbable strip, in layers, have non-permeable barrier layers, contain fluid absorbable or tamponade materials, and be made from any combination of absorbable or non-absorbable materials such as, by way of example, a polylactic acid and polydioxanone mix. The durometer of bandage  50  may be of any durometer making it soft and pliable, to firm or hard for palpability or structure (scaffolding). Bandage  50  by way of example, may be pre-impregnated with or contain compounds or combinations thereof such as but not limited to adhesives  62 , additives  64 , and/or adhesive initiators  65  described in greater detail below. Additionally, by way of example, the bandage  50  can increase in volume by having tamponade properties. 
         [0031]    Additives  64  can be combined with the bandage  50 . For example, the bandage  50  could be impregnated with an adhesive initiator  64  such that when the bandage  50  is in place, the surgeon places an adhesive  62  onto the bandage  50  and the initiator induces polymerization of the adhesive and “sets up” the adhesive  62 . Alternately, by way of example, the bandage  50  could be pre-coated with an adhesive  61  and the fluid  61  applied to the bandage could be an adhesive initiator  65  that initiates or “sets up” the adhesive  62  in the bandage. Or, by way of another example, the bandage could contain an alternate radio-opaque additives  64  such as barium and an adhesive initiator  65 . In this example, the fluid  61  in the fluid dispenser  60  is an adhesive  61  that sets up when combined with the adhesive initiator  65 . 
       The Fluid Dispenser 
       [0032]    The fluid dispenser  60  contains a fluid  61  that can induce adhesion of the bandage  50  to the intestinal tissue. Fluid  61  is sealed within the fluid dispenser  60  by a break-away cap  63 . Fluid  61  can be an adhesive  62  or an adhesive initiator  65  that can be combined with one or more additives  64 . Fluid dispenser  60  could be made from one or more parts of any one of a number of materials or combinations of materials such as but not limited to, plastic materials including butyrate or polyethylene rubber, silicone or plastic material, such as, for example, polyvinyl chloride, polyethylene, polyurethane, natural or nitril rubber, or any combination thereof. 
       Adhesives 
       [0033]    As described above, the adhesive  62  could be but is not limited to polymerizable and/or cross-linkable materials such as a cyanoacrylate adhesive. The adhesive materials, for example, may be a monomeric (including prepolymeric) adhesive composition, a polymeric adhesive composition, or any other compound that can adhere to tissue. In embodiments, the monomer may be a 1,1-disubstituted ethylene monomer, e.g., an .alpha.-cyanoacrylate. When cross linked or polymerized, the cyanoacrylate can change from a liquid to a solid. Polymerized adhesives for example, can be formulated to be flexible to rigid. If desired, adhesives can be a single part or dual part adhesive, and/or can contain one or more additives  64 . Polymerization of the adhesive  62  can occur from, but is not limited to, exposure to moisture, saline, temperature, or exposure to catalysts such as adhesive initiators  65   
       Adhesive Initiators 
       [0034]    Adhesive initiators  65  are for polymerization and/or cross-linking of a polymerizable monomer such as adhesive  62 . As used herein, a polymerization initiator is any material that causes a monomer composition applied to a substantially dry tissue (i.e., substantially in the absence of plasma or like tissue fluids) to polymerize in less than 300 seconds at ambient temperature, for example, at approximately 21-25 .degree. C. Preferably, the initiator causes the monomer composition to polymerize in less than 150 seconds at ambient temperature, more preferably within 60, 90 or 130 seconds. As used herein, a polymerization rate modifier is any material that changes the rate at which a polymerizable monomer would polymerize in the absence of that material. Preferably, the rate modifier accelerates the rate of the polymerization reaction, although for particularly fast-acting monomers it may decelerate that rate. 
         [0035]    Particular initiators  65  for particular monomers may be readily selected by one of skill in the art without undue experimentation. Control of the molecular weight distribution of the applied adhesive can be enhanced by selection of the concentration and functionality of the initiator or accelerator vis-à-vis the selected monomer. Suitable polymerization initiators and accelerators for cyanoacrylate compositions include, but are not limited to, detergent compositions; surfactants, including nonionic surfactants such as polysorbate  20  (e.g., Tween 20.™; ICI Americas), polysorbate 80 (e.g., Tween 80.™; ICI Americas), and poloxamers; cationic surfactants such as tetrabutylammonium bromide; anionic surfactants, including quaternary ammonium halides such as benzalkonium chloride or its pure components, and benzethonium chloride; stannous octoate (tin (II) 2-ethylhexanoate), and sodium tetradecyl sulfate; and amphoteric or zwitterionic surfactants such as dodecyldimethyl(3-sulfopropyl) ammonium hydroxide, inner salt; amines, imines, and amides, such as imidazole, tryptamine, urea, arginine and povidine; phosphines, phosphites and phosphonium salts, such as triphenylphosphine and triethyl phosphite; alcohols such as ethylene glycol; methyl gallate; inorganic bases and salts, such as sodium bisulfite, magnesium hydroxide, calcium sulfate and sodium silicate; sulfur compounds such as thiourea and polysulfides; polymeric cyclic ethers such as monensin, nonactin, crown ethers, calixarenes and polymeric epoxides; cyclic and acyclic carbonates, such as diethyl carbonate; phase transfer catalysts such as Aliquat.™ 336 (General Mills, Inc., Minneapolis, Minn.); organometallics; manganese acetylacetonate; radical initiators and radicals, such as di-t-butyl peroxide and azobisisobutyronitrile; and bioactive compounds or agents. 
         [0036]    Alternately, the initiator may be a bioactive material, including quaternary ammonium halides such as alkylbenzyldimethylammonium chloride (benzalkonium chloride; BAC) its pure components, or mixtures thereof, especially those with an alkyl containing 6-18 carbon atoms; benzethonium chloride; and salts of sulfadiazine. Cobalt napthenate can be used as an accelerator for peroxide. Other suitable bioactive materials are disclosed in U.S. Pat. No. 5,928,611 to Leung and U.S. patent application Ser. No. 08/920,876, filed Aug. 29, 1997, Ser. No. 09/430,176 filed Oct. 29, 1999, and Ser. No. 09/430,177, filed Oct. 29, 1999, the entire disclosures of which are incorporated herein by reference. 
       Additives 
       [0037]    If desired, one or more additives  64  can be added or applied to the bandage  50 , the stent  40 , or the adhesive  62 , and the adhesive initiator  65 . These additives can have a number of uses such as therapeutic, medicinal, adhesion enhancers, and the like. Examples of suitable additives  64  include, but are not limited to, anesthetics, sclerotic or necrosing agents plasticizing agents, thixotropic agents, buffers, catalysts, adhesive initiators, fillers, micro particles, thickeners, solvents, drugs, medicaments, stabilizers, pH modifiers, bioactive agents, cross-linking agents, chain transfer agents, fibrous reinforcements, colorants, preservatives, formaldehyde reducing or scavenging agents, flavorants, perfumes, mixtures thereof, and the like. Many suitable adhesives  62 , adhesive initiators  65  and additives  64  may be found in U.S. Application 20040190975 by Goodman et al. which is hereby incorporated by reference in its entirety. Alternately, one or more additives  64  can coat the stent  40 . 
       Method of Use 
       [0038]    The method of use of the anastomosis device proceeds as follows. The patient has been opened and a tumor has been found in a section of the jejunum. A portion of the jejunum containing the tumor and margins has been excised. The surgeon will now use the present invention to perform an end to end anastomosis of the two cut segments of the jejunum. In  FIG. 2 , the surgeon has inserted approximately half of the stent placement device  30  into a first portion  75  of the severed jejunum. In  FIG. 3 , the surgeon has partially inflated the balloon  32  by one or more strokes of the plunger  38  of the pump assembly  34 . As the balloon enlarges, the radially outward pressure of the expanding balloon permanently expands the stent  40  to the size shown. In  FIG. 4 , the balloon  32  and stent  40  have been fully expanded by multiple strokes of the plunger  38  to a size deemed adequate by the surgeon, a size wherein the inner diameter of the stent  40  is slightly larger than the inner diameter of the first portion  75  of jejunum. 
         [0039]    In  FIG. 5 , the stent  40  is fully expanded to the selected diameter and the balloon  32  and hollow catheter  33  have been removed. Once deployed the stent  40  applies a radial pressure on the jejunum opening, both keeping it open and allowing for easy manipulation during the procedure. To remove the balloon  32  and hollow catheter  33 , the surgeon has actuated the release valve  39  to vent the pressurized air within the balloon  32  to atmospheric, has applied a vacuum to the venting passageway  36   a  to deflate the balloon  32 , and removed the deflated balloon  32  and catheter  33  from within the stent  40 . The surgeon has also everted or folded the free end of the first portion  75  of jejunum over to create an everted tissue fold  76  exposing the inside layer of the tissue in an external radial fashion as shown. 
         [0040]    Now turning to  FIG. 6 , the second portion  80  of the jejunum is grasped between jaws  101  of a grasper  100  then pulled over both the remaining part of the stent  40  and the rolled first tissue fold  76  of jejunum  75 . This action places the inside of the first portion  75  of jejunum in direct contact with the inside of the adjacent second portion  80  of jejunum. 
         [0041]    A radial layer of bandage  50  is then placed in a continuous band of one or more layers around the first portion  75  of jejunum, the second portion  80  of jejunum, and around the everted first tissue fold  76  as shown in  FIG. 7 . Bandage  50  is impregnated with an adhesive initiator  65  to induce polymerization of an adhesive. The adhesive initiator  65  and bandage  50  are generally dry, and bandage  50  can be repositioned any number of times until the surgeon is satisfied with the placement. 
         [0042]    Once the bandage  50  has been placed in position, the dispenser  60  is opened by breaking the cap  63  off. As shown in  FIG. 8  adhesive  62  is applied onto the bandage  50  from the dispenser  60 . Only enough adhesive  62  is used to saturate the bandage  50  until the tissue below is in contact with the adhesive  62 . The adhesive initiator  65  on the bandage  50  ensures curing of the adhesive  62  is nearly instantaneous. The rapid curing prevents adhesive  62  from dripping, and prevents bandage  50  from adhering to adjacent structures inadvertently. If desired, after applying the adhesive  62 , the surgeon can use dye or pressure to check for leaks, and if required, a simple touch-up of adhesive  62  is used to block the leaks. 
         [0043]    In an alternate embodiment of the method, one could perform a mucosal to mucosal anastomosis by inverting the mucosa of one tissue portion onto the active stent adhesive and pulling the second tissue portion with its mucosa likewise inverted over the stent and first leg. All other steps being equivalent 
         [0044]    In an alternate embodiment of the device, the bandage  60  can contain the adhesive  62  and the dispenser  60  can contain an adhesion initiator  65 . Application of adhesive initiator  65  onto the bandage  50  sets the adhesive  62 . 
         [0045]    Also, expanding/foaming adhesives can also be used that would further insure the adhesion of all of the structures, even in the folds of the jejunum. 
         [0046]    It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material. 
         [0047]    While the present invention has been illustrated by description of several embodiments and while the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art. 
         [0048]    For example, whereas the stent placement device described above is a balloon  33 , the stent  40  could be formed from a shape memory alloy such that the stent placement device is the body temperature that makes the stent constructed from the shape memory alloy undergo a phase change and revert to a larger diameter. Alternately, heating devices such as resistive heaters could be used to as the stent placement device, or a series of interlocking expanding wedges or any other device or means that can change a cylindrical stent from a small diameter to a larger diameter.