Small intestine anastomosis by full thickness, single layer and interrupted suture technique: results of a comparative study


  • Shobhit K. Nemma Department of Surgery, GGS Medical College, Faridkot, Punjab, India
  • Sarbjeet Singh Department of Surgery, GGS Medical College, Faridkot, Punjab, India
  • Amritpal Singh Rana Department of Surgery, GGS Medical College, Faridkot, Punjab, India
  • Rohit Kapoor Department of Surgery, GGS Medical College, Faridkot, Punjab, India
  • Puneet Bansal Department of Surgery, GGS Medical College, Faridkot, Punjab, India



Full thickness sutures, Interrupted technique, Intestinal anastomosis


Background: Since the dawn of surgery intestinal anastomosis has remained a controversial topic in respect to suture material, anastomotic technique, distance between stitches and borders. Technique of anastomosis is an important determinant in process of anastomosis healing. Despite a large amount of work done on anastomosis techniques, a clear superiority of one technique over another has not been established.

Methods: Patients of ileostomy reporting to surgery department for stoma closure were used for study. 80 patients of ileostomy reporting for stoma closure were used as material for the study and randomized in two groups. In single layer group, using 3-0 silk suture, we performed small intestine anastomosis applying single layer of interrupted sutures taking full thickness bite. In double layer group, anastomosis was performed anastomosis by applying first layer of full thickness sutures and second layer of seromuscular sutures. The results were compared in terms of operative time, post operative complications, mortality, hospital stay and cost of the suture material.

Results: The mean age of the patients was 33.55 yr in group A (single layer) and 35.85 yr in group B (double layer). Total 7 patients developed anastomotic leak. 5 (12.5%) patients were with double layer anastomosis and 2 (5%) patients were in single layer group. The difference in anastomosis leak in two groups was statistically insignificant (p = 0.232). The mean duration of whole procedure in group A (single layer) was 52.5min and 71.5min in group B (double layer). The difference in mean duration of the procedure was found to statistically significant (P = 0.00).

Conclusions: We concluded the single layer technique to be a safe, efficient and more cost effective as compared to double layer technique.


Hussain S, Aslam V, Rahman S, Khan SM. Single layer continuous versus single layer interrupted extra mucosal technique in small intestinal anastomosis. PJMHS. 2015;9:1312-5.

Kirk RM, Winslet M. Essential General Surgical Operations. Edinburgh: Churchill Livingstone; 2001.

Mehmood Y, Rashid HU, Hanif N. Comparison of single with double layer intestinal anastomosis. Isra Med J. 2012;1(1):26-8.

Pickleman J, Watson W, Cunningham J, Fisher SG, Gamelli R. The failed gastrointestinal anastomosis: an inevitable catastrophe? J Am Coll Surg. 1999;188(5):473-82.

Sajid MS, Siddiqui MRS, Baig MK. Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database of Systematic Reviews. 2012;1:CD005477.

Burch JM, Franciose RJ, Moore EE, Biffl WL, Offner PJ. Single-layer continuous versus two-layer interrupted intestinal anastomosis. a prospective randomized trial. Ann Surg. 2000;231(6):832-7.

Mooloughi S, Joudi M, Dalili A, Dalili A. Different types of anastomotic methods: a review of literature. Reviews Clin Med. 2015 Oct 1;2(4):178-81.

Brooks DC, Zinner MJ. Surgery of the small and large bowel. Maingot’s abdominal operations, Volume 2. 10th ed. In: Zinned MJ editor. Stamford: Appelton and lange; 1997:1309-1310.

Farquharson M, Moran B. General Techniques in abdominal and gastrointestinal surgery. Farquharson’s textbook of operative general surgery. 9th Ed. In: Joanna Koster and Sarah Burrows editors. Great Britain: Hodder Education; 2005:224-225.

Yogendra, Ali M. A comparative study of single layer interrupted extramucosal (serosubmucosal) and double layer intestinal anastomosis. Int J Allied Med Sci and Clin Res. 2016;4(1):121-6.

Ordorica-Flores RM, Bracho-Blanchet E, Nieto-Zermeño J, Reyes-Retana R, Tovilla-Mercado JM, Leon-Villanueva V, et al. Intestinal anastomosis in children: a comparative study between two different techniques. J Pediatr Surg. 1998;33:1757-9.

Garude K, Tandel C, Rao S, Shah NJ. Single layered intestinal anastomosis: a safe and economic technique. Indian J Surg. 2013;75(4):290-93.

Abdella MR, Fathi M, EI-Sayed A, Shehata A. Is single- layer better than double layer interrupted intestinal anastomosis? A comparative study in pediatric patients. Egypt J Surg. 2018;37:9-15.

Bhargava GS, Singh H, Singh J. Single or double layer intestinal anastomosis. Int Surg J. 2016;3(4):2173-6.

Dandi PP, Aaudichya AS, Juneja IA, Vaishanani BV, Bhatt JG. A prospective comparative study of intestinal anastomosis, single layer extramucosal versus double layer. Int Res J Med Sci. 2015;3(8):2099-104.






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