Abstract
Background: The main objective was to compare the outcome of single layer interrupted extra-mucosal sutures with that of double layer suturing in the closure of colostomies.
 Subjects and Methods: Sixty-seven patients with closure colostomy were assigned in a prospective randomized fashion into either single layer extra-mucosal anastomosis (Group A) or double layer anastomosis (Group B). Primary outcome measures included mean time taken for anastomosis, immediate postoperative complications, and mean duration of hospital stay. Secondary outcome measures assessed the postoperative return of bowel function, and the overall mean cost. Chi-square test and student t-test did the statistical analysis..
 Results: Thirty-two patients were allocated to group A and 35 patients to group B. The mean time taken for anastomosis was significantly shorter in group A (23.25 ± 1.20 min in group A vs. 36.71 ± 1.93 min in group B; P<0.001). A significant shorter duration of hospital stay was seen in group A (7.00 ± 1.778 days in group A vs. 9.74 ± 1.990 days in group B; P<0.001). The detection of bowel sound was substantially quicker in group A as compared to group B (4.56 ± 0.50 days in group A vs. 6.46±0.50 days in group B; P<0.001). There was no significant discrepancy between the two groups regarding anastomotic leak rates (P= 0.543). The mean cost of double layer intestinal anastomosis method was significantly higher than that of single layer anastomosis (P<0.001).
 Conclusions: The use of single layer extra-mucosal anastomosis of the intestine has the advantage of taking less time, less morbidity and cost-effective to perform with the same rate of anastomotic leak in the closure of colostomy.
Highlights
The intestinal anastomosis is a fundamental procedure in gastrointestinal surgery
The mean time taken for anastomosis was significantly shorter in group A (23.25 ± 1.20 min in group A vs. 36.71 ± 1.93 min in group B; P
Primary outcome measures included mean time taken for anastomosis in minutes, the incidence of postoperative complications, the mean duration of hospital stay
Summary
The intestinal anastomosis is a fundamental procedure in gastrointestinal surgery. A significant challenge is the integrity of the anastomosis to avoid the risk of anastomotic leaking and subsequent high morbidity and mortality rates.[1,2] a variety of techniques, materials, and devices have been used successfully to achieve intestinal anastomosis in the past 150 years, there is no single technique which is internationally accepted.[3,4] Historically two-layer anastomosis has been approved for most medical situations, but, it is slightly dull, time wasting to complete, and costly technique.[5,6,7] Single layer extra-mucosal anastomosis using synthetic absorbable suture material has gained popularity as it requires less time and cost without incurring any added risk of leakage, and associated with improved postoperative return to normal bowel function.[8,9] In developed countries intestinal anastomosis is mainly performed by staplers; manual anastomoses (single interrupted, single continuous, double layer) are still in use worldwide.[10]. The main objective was to compare the outcome of single layer interrupted extra-mucosal sutures with that of double layer suturing in the closure of colostomies. Subjects and Methods: Sixty-seven patients with closure colostomy were assigned in a prospective randomized fashion into either single layer extra-mucosal anastomosis (Group A) or double layer anastomosis (Group B). Primary outcome measures included mean time taken for anastomosis, immediate postoperative complications, and mean duration of hospital stay. Secondary outcome measures assessed the postoperative return of bowel function, and the Keywords: Single layer anastomosis; double layer anastomosis, Closure colostomy. The mean time taken for anastomosis was significantly shorter in group A (23.25 ± 1.20 min in group A vs 36.71 ± 1.93 min in group B; P
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