DOI: http://dx.doi.org/10.18203/2349-2902.isj20205363

An observational comparative study of single layer continuous extramucosal anastomosis versus conventional double layer intestinal anastomosis

Suchin S. Dhamnaskar, Anil Baid, Nishant Gobbur, Pratik Patil

Abstract


Background: Conventional double layered technique of intestinal anastomosis are widely in practise. Some surgeons also practice single layer technique either continuous or interrupted. This was a prospective observational study to compare safety, efiicacy and feasibility of single versus double layered continuous techniques.

Methods: Patients undergoing intestinal anastomosis with either of these two techniques were observed prospectively for various outcome parameters like length of suture material used, time taken for anastomosis, and that for entire surgery, postoperative complications, return of bowel activity etc. Data such obtained was analysed for statistical significance by applying chi-square test and unpaired ‘t’ test.

Results: Length of suture used for single layer (mean of 15.06 cm) was statistically significantly lesser than that for double layer (mean 19.90 cm) (p.0.001). Time taken for anastomosis and overall surgical time too was significantly less for single layer group (p.0.001 and 0.022 respectively). Complications including anastomotic dehiscence were not significantly different between two groups. Postoperative recovery of bowel function was earlier in single layer group with marginal statistical significance (p=0.048).

Conclusions: Thus in our study, single layer continuous method of intestinal anastomosis resulted in significant reduction in time, suture material length and cost; without any difference in complications and it marginally hastens the postoperative recovery of bowel function. So single layer continuous method can be recommended for intestinal anastomosis.


Keywords


Anastomosis, Anastomotic dehiscence, Double layer continuous, Postoperative recover, Single layer continuous

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References


Egger M, Smith GD, Schneider M, Minder C, Noguchi Y, Gavaghan D, et al. Bias in metaanalysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-34.

Kostić LL. Sutures in digestive surgery. Acta Chir Iugosl. 1994 ;41(2):211-20.

Pathak A, Rahaman MA, Mishra S. Single-layer versus double layer intestinal anastomosis of small bowel at Nepalgunj teaching hospital. J Nepalgunj Med Coll. 2015;12(1):35.

Sajid MS, Siddiqui MRS, Baig MK. Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database System Rev. 2012;CD005477.

Garude K, Tandel C, Rao S, Shah NJ. Single layered intestinal anastomosis: a safe and economic technique. Indian J Surg. 2013;75(4):290-3.

Single-layer continuous versus two-layer interrupted intestinal anastomosis. Available at http:// journals. lww.com/annalsofsurgery/Abstract/2000/06000/Single_Layer_Continuous_Versus_Two_Layer.7.aspx. Accessed on 10 August 2020.

Kar S, Mohapatra V, Singh S, Rath PK, Behera TR. Single layered versus double layered intestinal anastomosis: a randomized controlled trial. J Clin Diagn Res. 2017;11(6):1-4.

Baviskar PK, Jorwekar GJ, Professor A, Dandekar KN, Shah BA, Jain P. Indian medical gazette comparative study comparison of single layer versus double layer continuous anastomotic technique for small bowel resection and anastomosis. 2014

Bhargava GS, Singh H, Singh J. Single or double layer intestinal anastomosis? Int Surg J. 2016;3(4):173-6.

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.

Ayub M, Sheikh R, Gangat S. Single layer versus two layer intestinal anastomosis -a prospective study. Pak J Surg. 2009;25(3):141-4.

Shikata S, Yamagishi H, Taji Y, Shimada T, Noguchi Y. Single versus two layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg. 2006;6:2.

Pathak A, Rahaman A, Mishra SM. Single layer intestinal anastomosis of small bowel at Nepalganj Teaching Hospital. J Nepalganj Med College. 2015;12(1):35.

Leslie A, Steele RJC. The interrupted serosubmucosal anastomosis still the gold standard. Colorectal Dis. 2003;5(4);362-6.

Sliekar JC, Daams F, Mulder IM, Jeekel J, Lange JF. Systematic review of the technique of colorectal anastomosis JAMA Surg. 2013;148(2);190-201.

Saboo R, Deshmukh SD, Sonarkar R, Agrawal VP, Shah P. A comparative study of single layer continuous sutures versus double layer interrupted sutures in intestinal anastomosis. IJBAR. 2015;6(3);264-8.