DOI: http://dx.doi.org/10.18203/2349-2902.isj20213181

Study of clinical outcome of patients undergoing intestinal anastomoses with single layer extramucosal technique and double layer anastomoses

Arvind Rai, Sukantth R. J.

Abstract


 

Background: Intestinal anastomosis is one of the common surgeries for cases like bowel obstruction, incarcerated hernias, benign and malignant tumours of small and large bowel. The ideal intestinal anastomosis does not leak and allow normal function of the gastrointestinal tract. This study compared single layer versus double layer  intestinal anastomosis in terms of duration, postoperative complications like anastomotic leak.

Methods: A total of 100 patients admitted in Hamidia hospital, based on history and clinical examinations and radiological examinations, placed in two groups, group A (single layer anastomosis) and group B (double layer anastomosis) and were operated by a qualified surgical specialist. Data analysis of anastomotic time, anastomotic leak was done and statistical tests of significance were applied. A p value less than 0.05 is considered as significant.

Results: In group A (single layer) the time required to perform in 30 (60%) patients is between 16-20 minutes. In double layer, maximum were done in between 26 to 30 minutes, 32 (64%). In our study of 100 patients, there were 6 anastomotic leaks, of which four of them were in group A (single layer) and 2 of them in group B (double layer).

Conclusions: In our study, the duration required to perform a single layer intestinal anastomosis is significantly lesser when compared to double layer. There is no significant difference in anastomotic leak between two groups. Less time with no difference in complications, a move towards single layer anastomosis should be preferred.


Keywords


Intestinal anastomosis, Single layer, Double layer anastomoses, Anastomotic leak

Full Text:

PDF

References


Kate V, Roberts KE. Intestinal anastomosis. Clinic Proced. 2020.

Nichols RL, Condon RE. Preoperative preparation of the colon. Surg Gynecol Obstet. 1971;132(2):323-37.

Brooks DC, Zinner MJ. Surgery of the Small and Large Bowel. In: Zinner MJ, eds. Maingot's Abdominal operations. 13th ed. Stanford: Appleton and Lange; 1997: 1309-10.

Hautefeuille P. Gastrointestinal suturing: Apropos of 570 sutures performed over a 5-year period using a single layer continuous technique. Chirurgie. 1976;102(2):153-65.

Goulder F. Bowel anastomoses: the theory, the practice and the evidence base. World J Gastrointest Surg. 2012;4(9):208-13.

Kodigehalli M, Eto K, Hashizume R, Takeda M, Tomori K, Neki K, et al. Which is the safer anastomotic method for colon surgery? Ten-year results. In Vivo. 2017;31(4):683-7.

Thomson WHF, Robinson MHE. One-layer continuously sutured colonic anastomosis. Br J Surg. 1993;80(11):1450-1.

AhChong AK, Chiu KM, Law IC, Chu MK, Yip AW. Single-layer continuous anastomosis in gastrointestinal surgery: a prospective audit. Aust N Z J Surg. 1996;66(1):34-6.

Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011;2011(9):001544.

Richard L, Alexander T. Methods of wound closure. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia: Saunders; 2017: 671.

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.

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(12):1757-9.

Sai KL, Sugumar C. A comparative study of single layer extra mucosal versus conventional double layer anastomosis of intestines in elective and emergency laparotomy. Int Surg J. 2020;17(1):184-8.