An implantable medical device (40, 300, 400) for connecting tissue layers to form an anastomosis, eg, for connecting a portion of the gallbladder and a portion of the gastrointestinal tract, includes a plurality of apposition portions (302, 304). A tubular structure having a central portion (306), and a dressing. The instrument includes a flange member (308, 310) disposed under an endoscope and having a hinge member (322) having various characteristics such as length, angle, profile, material stiffness, and wire diameter. [Selection] Figure 2吻合を形成するために組織層を接続するための、例えば、胆嚢と胃腸管の一部を接続するための移植可能医療器具（４０、３００、４００）は複数の並置部（３０２、３０４）を有する管状構造体、中央部（３０６）、及び被覆材を含む。前記器具は内視鏡下で配置され、長さ、角度、外形、材料剛性、及び線径などの様々な特性を有するヒンジ部材（３２２）を持つフランジ部材（３０８、３１０）を含む。【選択図】図２
