Published: 2019-06-29

Comparison between extra mucosal continuous prolene repair versus interrupted through and through silk repair in colonic anastomosis

Ashok Kumar Nayak, Malaya Krishna Nayak, Dharbind Kumar Jha, Chinmaya Kar, Debashree Maharana


Background: The traditional double layered colonic anastomosis incorporates large amount of ischemic tissue in the suture line causing luminal narrowing and fistula formations. Single layered anastomosis may be done through continuous extramucosal suturing or by interrupted through and through technique using nonabsorbable materials. The single layer of suture has shown to be safe and causes fewer complications.

Methods: The study was conducted in the Department of surgery, VIMSAR, Burla during the period from October 2016 to September 2018. All the patients of colonic anastomosis were included in the study. One group consists of extra mucosal continuous prolene repair and other interrupted though and through silk repair. Both groups were followed up and were compared taking different variables.

Results: 146 cases of colonic anastomosis were performed, 110 with interrupted through and through silk repair (75.34%) and 36 with continuous extra mucosal prolene repair (24.66%).The mean time taken for silk repair was more (25.67 min) than prolene  (15.5 min). The patients of prolene repair had shorter duration (9 days) of hospital stay than silk (12.4 days). The postoperative ileus was more in silk (16.36%) than prolene (5.56%). Anastomotic leak in prolene is less (2.78%) in comparison to silk (8.18%). The bowel movement appeared earlier with prolene (4.2 days) is less than ssilk (5.3 days).

Conclusions: The present study shows single layer monofilament thin diameter prolene for different end to end colonic anastomosis has better prognostic panorama in relation to morbidity and mortality, and had an edge over conventional single or bilayere anastomosis.



Colonic anastomosis, Extra mucosal continuous prolene repair, Interrupted silk repair

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Irwin ST, Krukowski ZH, Matheson NA. Single-layer anastomosis in the upper gastrointestinal tract. Br J Surg. 1990;77:643-4.

Max E, Sweeney B, Bailey HR. Results of 1,000 single-layer continuous polypropylene intestinal anastomoses. Am J Surg. 1991;162:461-7.

Ceraldi CM, Rypins EB, Monahan M. Comparison of continuous single-layer polypropylene anastomosis with double-layer and stapled anastomoses in elective colon resections. Am Surg. 1993;59:168-71.

Steele RJC. Continuous single-layer serosubmucosal anastomosis in the upper gastrointestinal tract. Br J Surg. 1993;80:1416-7.

Thomson WHF, Robinson MHE. One-layer continuously sutured co-lonic anastomosis. Br J Surg. 1993;80:1450-1.

AhChong AK, Chiu KM, Law IC. Single-layer continuous anastomosis in gastrointestinal surgery: a prospective audit. Aust NZ J Surg. 1996;66:34-6.

Brodsky JT, Dadian N. Single-layer continuous suture for gastrojeju-nostomy. Am Surg. 1997;63:395-8.

Law WL, Bailey HR, Max E. Single-layer continuous colon and rectal anastomosis using monofilament absorbable suture (Maxon): study of 500 cases. Dis Colon Rectum. 1999;42:736-40.

Travers B. Enquiry into the Process of Nature in Repairing Injuries of the Intestine. London: Longman, Rees, Orme, Brown, and Green; 1812.

Gambee LP, Garnjobst W, Hardwick CE. Ten years’ experience with a single-layer anastomosis in colon surgery. Am J Surg. 1956; 222-7.

Bronwell AW, Rutledge R, Dalton ML. Single-layer open gastrointes-tinal anastomosis. Ann Surg. 1967;165:925-32.

Allen TW, Salem RJ, Stirman JA. Continuous suture for single-layer enteroanastomosis. Read before the Texas Surgical Society, Austin, TX; 1979.

Bailey HR, LaVoo JW, Max Es. Single-layer continuous colo-rectal anastomosis. Aust NZ J Surg. 1981;51:473-6.