Double-layer Anastomosis Research Articles

Pancreas Transplantation: a retroperitoneal graft placement

Background: Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the “normal” pancreas.We herein present a video with the pancreas placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodeno-duodenostomy. Methods: Back-table preparation was performed prior to transplantation.The donor duodenum was reduced to a length of 8–12 cm.The arterial reconstruction of the graft was created by anastomosis end-to-end between the splenic artery and distal superior mesenteric artery. Results: In the recipient,a median laparotomy was done for surgical access.The right colon was then mobilized and a Kocher manoeuvre was performed to expose the retroperitoneal site along with the vena cava and iliac vessels.The venous anastomosis was performed end-to-side between donor portal vein and recipient vena cava.The arterial supply for the graft was provided by anastomosis end-to-side between the graft superior mesenteric artery with the recipient common right-iliac artery. For enteric drainage a duodeno-duodenostomy was performed side-to-side by means of a hand-sewn, double-layered anastomosis, at the level between the second and third portions of the recipient’s duodenum. A drain was inserted beside the pancreas graft, ending near the duodeno-duodenostomy. Finally, the colon was returned to its original position Conclusion: The retroperitoneal placement of the pancreatic graft imitates the physiological position of the organ.

Colostomy closure in post Conflict Iraq

Background: Colostomy minimizes the risk of leakage at expense of requiring a second operation. In Iraq, published on colostomy closure in penetrating abdominal wall injuries is scarce.
 Objective: to Study the prognosis of colostomy closure in post-conflict patients in Iraq.
 
 
 
 
 J Fac Med Baghdad 2018; Vol.60, No.3 Received: June, 2018 Accepted: Oct., 2018
 Published: Dec.2018
 
 
 
 
 
 
 
 Method: This is a retrospective study of 52 patients subjected to colostomy closure, recruited for the period 2008 to 2009 from Al-Yarmouk Teaching Hospital and Children Central Teaching Hospital. Demographic data and information about colostomy (type, methods of preparation … etc.) were studied.
 Results: Trauma was noticed in 57.7% patients. Transverse colon was the commonest site of injuries. The complications were wound infection (19.2%), fecal fistula (3.8%), anastomotic leak (1.9%) and abdominal abscess (1.9%). A significant high complication rate was associated with conventional method of preparation, and double layer anastomosis (p = 0.004 rand 0.003, respectively).
 Conclusion: the finding were comparable with other centers in the world.

غلق فغر القولون في عراق ما بعد الازمة

Background: Colostomy minimizes the risk of leakage at expense of requiring a second operation. In Iraq, published on colostomy closure in penetrating abdominal wall injuries is scarce. Objective: to Study the prognosis of colostomy closure in post-conflict patients in Iraq. J Fac Med Baghdad 2018; Vol.60, No.3 Received: June, 2018 Accepted: Oct., 2018 Published: Dec.2018 Method: This is a retrospective study of 52 patients subjected to colostomy closure, recruited for the period 2008 to 2009 from Al-Yarmouk Teaching Hospital and Children Central Teaching Hospital. Demographic data and information about colostomy (type, methods of preparation … etc.) were studied. Results: Trauma was noticed in 57.7% patients. Transverse colon was the commonest site of injuries. The complications were wound infection (19.2%), fecal fistula (3.8%), anastomotic leak (1.9%) and abdominal abscess (1.9%). A significant high complication rate was associated with conventional method of preparation, and double layer anastomosis (p = 0.004 rand 0.003, respectively). Conclusion: the finding were comparable with other centers in the world.

A Comparative Study of Single Layer Versus Double layer Intestinal Anastomosis

Objective: To determine the efficacy of single layer intestinal anastomosis to double layer technique in terms of anastomotic healing.
 Materials and Methods: Fifty patients who underwent intestinal anastomosis in the Department of Surgery, Western Regional Hospital from June 2014 to May 2016 were taken for this comparative study and divided equally in two groups, 25 each (single layer and double layer).
 Results: Of the total fifty cases, twenty-five cases included in each group, there was no leakage in single layer group while 1 patient had leakage in double layer group which was statistically insignificant.
 Conclusion: Single layer interrupted intestinal anastomosis is simple to carry out and is as efficacious as double layer anastomosis in terms of postoperative anastomotic leak.

Single-Port Thoracoscopic Minimally Invasive Esophagectomy for Esophageal Cancer.

This study was to explore the safety and feasibility of single-port thoracoscopic esophagectomy for esophageal cancer. The patients were placed in left lateral prone position, and a 4-cm incision through the 4th-5th intercostal space was taken on the post-axillary line. Except for a surgical wound protector, no other special instruments were used for single-port technique. The 10-mm camera and two or three thoracoscopic instruments were used for the thoracic phase. Mobilization of stomach with celiac lymph node dissection was performed via multiple-port laparoscopic approach. Cervical double-layered anastomosis was completed by hand-sewn technique. A total of twenty-eight patients with esophageal squamous cell carcinoma underwent the single-port thoracoscopic surgery. All of the patients underwent R0 resection. The median time taken for thoracic phase and total operation time were 126min (range, 121-153) and the 253min (range, 197-309), respectively. The median number of resected thoracic lymph nodes was 16 (range, 12-24). There were no deaths or severe postoperative complications in this study, with no conversion of minimally invasive surgery to open procedure. Our preliminary results demonstrate that this technique is safe and feasible for treating esophageal cancer within an acceptable length of operation time, which does not compromise the surgical radicality.

Comparison Study of Single Layer versus Double Layer Anastomosis in Bowel Surgery in Western India

Comparison Study of Single Layer versus Double Layer Anastomosis in Bowel Surgery in Western India

Modified Double-Layer Anastomosis for Minimally Invasive Esophagectomy: An Effective Way to Prevent Leakage and Stricture.

Anastomotic leakage and stricture contribute to a large number of mortality and morbidity after esophagectomy. The aim of this work is to evaluate the outcome of modified double-layer hand-sewn esophagogastric anastomosis during minimally invasive esophagectomy for esophageal cancer. The clinicopathological data of 176 consecutive esophageal cancer patients who underwent cervical esophagogastric anastomosis using modified double-layer hand-sewn technique after radical esophagectomy were retrospectively reviewed. Total minimally invasive approach, including thoracoscopic surgery for thoracic procedure and laparoscopic approach for abdominal procedure, was implemented during the radical Mckeown esophagectomy. Patients were followed up for the assessment of postoperative anastomotic complications including anastomotic leakage and stricture, being the primary outcome measures for this study. Anastomotic leakage occurred in 2 of 176 patients (1.1%); both of the patients experienced only minor leakage and were treated conservatively. There was no significant difference in leakage between patients with and without major comorbidity (p=0.331). After a mean follow-up of 21.3months, four patients (4/176, 2.3%) developed benign anastomotic strictures, including those 2 patients experienced postoperative leakage. Symptoms for stricture were improved by endoscopic dilatations in all 4 patients. Besides, there was one case (1/176, 0.6%) of gastric necrosis in this cohort, who was also successfully managed by conservative therapy with no operative mortality. This modified double-layer hand-sewn anastomosis is a highly safe and stable technique for esophagogastrostomy, which is an effective way to prevent both anastomotic leakage and stricture.

Single-layer versus double-layer intestinal anastomosis: A comparative study

Background: Intestinal anastomosis is essential to maintain the continuity after resection. There has been constant controversy due to various repair options. Adequate apposition can be achieved by either single- or double-layer anastomosis which may affect the post-operative outcome.Objective: To compare the outcome of single-layer versus double-layer anastomosis of small and large intestine.Method: This prospective comparative study was conducted over a period of 16 months, and included 78 patients who underwent intestinal anastomosis (without diverting stoma) after fulfilling inclusion and exclusion criteria. They were randomized into double-layer and single-layer intestinal anastomosis groups by a computer generated series. Double layer anastomosis was constructed using inner continuous Polyglactin 3-0 and outer interrupted Silk 3-0, while single layer anastomosis was done with interrupted PDS 2-0.Result: The mean age was 39.79±17.78 years. A total of 59% were operated in emergency room while 41% in elective setting. Overall mean time for anastomosis was 31.81±6.03 (21-50) minutes. In double- and single-layer intestinal anastomosis mean time was 34.35±5.80 (26-50) and 29.13±5.08 (21-45) minutes respectively, which was statistically significant (p value < 0.05). Single-layer was completed 5 minutes earlier than double layer anastomosis in average. Clinical anastomotic leak was seen in six (7.7%) patients, three in each group. Eight (10.3%) patients had surgical site infection: 3 in double-layer and 5 in single-layer groups. One (1.3%) mortality was seen, from single-layer anastomosis group.Conclusion: Single-layer anastomosis can be constructed in significantly shorter time with similar complication rate when compared to doublelayer anastomosis.Health Renaissance 2015;13(2): 134-143

Single Layered Versus Double Layered Intestinal Anastomosis: A Randomized Controlled Trial.

Gastrointestinal anastomosis is one of the most common procedures being performed in oesophagogastric, hepatobiliary, bariatric, small bowel and colorectal surgery; however, the safety and efficacy of single layer or double layer anastomotic technique is still unclear. To assess and compare the efficacy, safety and cost effectiveness of single layered versus double layered intestinal anastomosis. This prospective, double-blind, randomized controlled comparative study comprised of patients who underwent intestinal resection and anastomosis. They were randomly assigned to undergo either single layered extra-mucosal anastomosis (Group-A) or double layered intestinal anastomosis (Group-B). Primary outcome measures included average time taken for anastomosis, postoperative complications, mean duration of hospital stay and cost of suture material used; secondary outcome measures assessed the postoperative return of bowel function. Statistical analysis was done by Chi-square test and student t-test. A total of 97 participants were randomized. Fifty patients were allocated to single layered extramucosal continuous anastomosis (Group-A) and 47 patients to double layered anastomosis (Group-B). The patients in each group were well matched for age, sex and diagnosis. The mean time taken for anastomosis (15.12±2.27 minutes in Group-A versus 24.38±2.26 minutes in Group-B) and the length of hospital stay (5.90±1.43 days in Group-A versus 7.29±1.89 days in Group-B) was significantly shorter in Group-A {p-value <0.001}. The postoperative return of bowel function was quicker in the single layer group (2.42±1.11 days) as compared to the double layer group (3.1±1.34 days). The cost of suture material used was relatively more in the single layered group (564 INR vs. 480 INR) which might be the only factor favoring a double layered anastomosis. However, there was no significant difference in the complication rates between the two groups. It can be concluded that single layered extramucosal continuous intestinal anastomosis is equally safe and perhaps more cost effective than the conventional double layered method and may represent the optimal choice for routine surgical practice.

Minimizing Occurrence of Pancreatic Fistula during Pancreatoduodenectomy (Pd) Procedure: An Update

Background: Pancreatic fistula (PF) is the most widely recognized complication of pancreaticoduodenectomy (PD) with diversely reported occurrence rates. Present review focusses on dissecting the surgical treatment modalities that leads to development of PF. Methods: A retrospective study with the use of hospital database as cases and controls was carried out. Data were tabulated and subjected to strong statistical analysis and inferences were drawn. Results: As observed the occurrence of PF did not differ in terms of mean age, sex, surgical timings to the procedure, anastomosis techniques or vascular resection. Conclusion: The surgical approach for PF is related with a higher mortality and morbidity. There is no preferred method of performing pancreatectomy as any procedure can give rise to same mortality rates and risk of endocrine deficiency. In instances of muddled PF, radiological or surgical conservative treatment is needed and surgically duct to mucosal double layered anastomosis have been successful in reducing the PF rates and its validation is still awaited from the trials.

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis.

To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP); an updated systematic review of the literature. A systematic review of the literature was performed in June 2015, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the 'Title' and 'Abstract' fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed. In all, 21 studies were identified, including three randomised controlled trials. The overall analysis of comparative studies showed that PR improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after PR. There were no significant differences for positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. The analysis confirms the benefits at 30 days after catheter removal already discussed in the review published in 2012, but also shows a significant advantage in terms of urinary continence recovery in the first 90 days. A multicentre prospective randomised controlled trial is currently being conducted in several institutions around the world to better assess the effectiveness of PR in facilitating an earlier recovery of postoperative urinary continence.

Single-Layer Versus Double Layer Intestinal Anastomosis of Small Bowel at Nepalgunj Teaching Hospital

Background: Resection and anastomosis of small bowel is one of the common surgical procedure encountered in routine and emergency cases. There are various techniques of anastomosing the resected intestine.Objectives: To know the efficacy of single layer anastomosis over double layer anastomosis in terms of anastomotic leakage, wound infection, mortality and time consumed.Methods: A comparative cross sectional analytical study was carried out at department of General Surgery at Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal from January 2013 to December 2013. Altogether 62 patients who underwent resection and anastomosis of small bowel were considered for this study. Patients who were included in this study were equally divided into two groups. Group A (n=32) underwent single layer anastomosis and group B (n=30) were subjected to double layer anastomosis. In both the groups anastomotic leakage, wound infection, mortality and time consumed were recorded and compared.Results: Altogether 62 patients were included in the study. The study showed anastomotic leakage 3 (9.37%) in Group A and 2 (6.67%) in Group B. Wound infection was 6 (18.75%) in Group A and 4(13.33%) in Group B and mortality was observed in only 1(3.12%) patient in Group A due to uncontrolled sepsis. There was no statistical difference between the two groups in anastomotic leakage, wound infection and mortality as shown by respective p (0.696, 0.562, 0.329) values. However the time required for single layer bowel anastomosis was less in comparison to double layer bowel anastomosis.Conclusion: Based on our data, the technique of single layer of bowel anastomosis does not increase the rate of anastomotic leakage, wound infection and mortality however time required for anastomosis is less as compared to double layer anastomosis. Therefore this study concludes that there is no added benefit of double layer of anastomosis over single layer bowel anastomosis.Journal of Nepalgunj Medical College Vol.12(1) 2014: 35-38

Evaluation of risk factors affecting anastomotic leakage after repair of esophageal atresia.

Background:Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion: Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage.

A comparative study of single layer continuous sutures versus double layer interrupted sutures in intestinal anastomosis

Objectives : The objective of the study was to compare single layer continuous intestinal anastomosis and double layer interrupted intestinal anastomosis in terms of time taken for the anastomosis and safety. Material & Methods : A prospective comparative study was carried out in the Department of Surgery NKPSIMS and RC, Nagpur from August 2011 to October 2013. All patients who underwent elective intestinal surgeries and bowel anastomosis and consented for the study were included in the study. Patients requiring gastric, duodenal and rectal anastomosis and patients in whom staplers were used were excluded from the study. 30 single layered continuous and 30 double layered interrupted intestinal anastomosis were performed. Data was analyzed using Student t test for continuous variables and Chi square test for categorical variables. Comparison was made in terms of time taken for anastomosis, anastomotic leak and other complications. Results : The mean duration of intestinal anastomosis for the double layer group was 33.06 minutes whereas for the single layer group, it was 23.6 minutes, which was found to be statistically significant. Anastomotic leak was reported in 2 patients in the double layer group and in 3 patients in the single layer group was found to be statistically insignificant. The other complications that included surgical site infection, re intervention and mortality were similar in both the groups. Single layered intestinal anastomosis does not carry any increased risk of anastomotic leak and other complications when compared to double layered intestinal anastomosis and can be constructed in a shorter time. Conclusion : Single layered intestinal anastomosis technique takes less time for construction and does not carry any increased risk of complications

Application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy.

To investigate the simplicity, reliability, and safety of the application of single-layer mucosa-to-mucosa pancreaticojejunal anastomosis in pancreaticoduodenectomy. A retrospective analysis was performed on the data of patients who received pancreaticoduodenectomy completed by the same surgical group between January 2011 and April 2014 in the General Hospital of the People's Liberation Army. In total, 51 cases received single-layer mucosa-to-mucosa pancreaticojejunal anastomosis and 51 cases received double-layer pancreaticojejunal anastomosis. The diagnoses of pancreatic fistula and clinically relevant pancreatic fistula after pancreaticoduodenectomy were judged strictly by the International Study Group on pancreatic fistula definition. The preoperative and intraoperative data of these two groups were compared. χ(2) test and Fisher's exact test were used to analyze the incidences of pancreatic fistula, peritoneal catheterization, abdominal infection and overall complications between the single-layer anastomosis group and double-layer anastomosis group. Rank sum test were used to analyze the difference in operation time, pancreaticojejunal anastomosis time, postoperative hospitalization time, total hospitalization time and hospitalization expenses between the single-layer anastomosis group and double-layer anastomosis group. Patients with grade A pancreatic fistula accounted for 15.69% (8/51) vs 15.69% (8/51) (P = 1.0000), and patients with grades B and C pancreatic fistula accounted for 9.80% (5/51) vs 52.94% (27/51) (P = 0.0000) in the single-layer and double-layer anastomosis groups. Although there was no significant difference in the percentage of patients with grade A pancreatic fistula, there was a significant difference in the percentage of patients with grades B and C pancreatic fistula between the two groups. The operation time (220.059 ± 60.602 min vs 379.412 ± 90.761 min, P = 0.000), pancreaticojejunal anastomosis time (17.922 ± 5.145 min vs 31.333 ± 7.776 min, P = 0.000), postoperative hospitalization time (18.588 ± 5.285 d vs 26.373 ± 15.815 d, P = 0.003), total hospitalization time (25.627 ± 6.551 d vs 33.706 ± 15.899 d, P = 0.002), hospitalization expenses (116787.667 ± 31900.927 yuan vs 162788.608 ± 129732.500 yuan, P = 0.001), as well as the incidences of pancreatic fistula [13/51 (25.49%) vs 35/51 (68.63%), P = 0.0000], peritoneal catheterization [0/51 (0%) vs 6/51 (11.76%), P = 0.0354], abdominal infection [1/51 (1.96%) vs 11/51 (21.57%), P = 0.0021], and overall complications [21/51 (41.18%) vs 37/51 (72.55%), P = 0.0014] in the single-layer anastomosis group were all lower than those in the double-layer anastomosis group. Single-layer mucosa-to-mucosa pancreaticojejunal anastomosis appears to be a simple, reliable, and safe method. Use of this method could reduce the postoperative incidence of complications.

Contemporary outcomes of seminal tract re-anastomoses for obstructive azoospermia: a nationwide Japanese survey.

To evaluate current outcomes of seminal tract re-anastomoses in Japan, and to compare them with historical data. A total of 213 patients with obstructive azoospermia who underwent seminal tract re-anastomosis from April 2008 to March 2012 at 25 institutions were enrolled in the present study. The outcomes of the procedure were compared with those reported in a previous multi-institutional study carried out in 2000. The percentage of partners aged over 35 years was 37%. A microsurgical double-layer anastomosis was carried out 83.0% of the time. Sperm were observed in ejaculate postoperatively in 68.9% and 41.5% of patients who underwent a vasovasostomy or a vasoepididymostomy, respectively. Natural conception occurred in 27.5% of patients after a vasectomy and 32.3% of patients with an epididymal obstruction. Except for the ratio of natural conception in patients with vasal obstruction after herniorrhaphies, there were no significant differences in final ratios of sperm appearance and natural conception between the previously reported study and the present study. Compared with historical data, contemporary seminal tract re-anastomosis in Japan seems to provide equivalent or better outcomes, depending on the cause of obstruction. Seminal tract re-anastomosis is a valid treatment option for patients with obstructive azoospermia.

A Retrospective Study Comparing the Outcome of Horses Undergoing Small Intestinal Resection and Anastomosis With A Single Layer (Lembert) or Double Layer (Simple Continuous and Cushing) Technique

To (1) compare postoperative complications and survival in horses after small intestinal resection and anastomosis using 2 anastomosis techniques (single layer Lembert; double layer simple continuous oversewn with Cushing), and (2) to compare outcome by anastomosis type (jejunoileostomy; jejunojejunostomy). Retrospective case series. Horses (n = 53). Medical records (July 2006-July 2010) of all horses that had small intestinal resection and anastomosis. Horses were divided into groups based on technique and type of anastomosis. Comparisons of pre- and intraoperative findings (disease severity), postoperative complications, and survival rates were made between groups. There were no differences in disease severity, postoperative complications, or survival between single layer (n = 23) or double layer (n = 31) anastomoses. There were no differences in disease severity or survival between jejunoileostomy (n = 16) or jejunojejunostomy (n = 38). There was a higher incidence of postoperative colic in hospital after jejunoileostomy (13/16) compared with jejunojejunostomy (18/38) (P = .0127). Postoperative complications and survival are comparable between horses undergoing single layer and double layer small intestinal end-to-end anastomoses. With the exception of increased postoperative colic in the hospital, postoperative complications and survival after jejunoileostomy and jejunojejunostomy are also comparable.

Comparative Study of Different Anastomotic Technique- Single Layer Extra Mucosal Versus Conventional Double Layer Anastomosis in Elective and Emergency Laparotomy

The present study was conducted to compare the efficacy of Two hand sewn techniques of gut anastomosis (i.e. single and double layer). This prospective study was conducted in department of Surgery, JA Group of Hospitals, G.R.M.C Gwalior. 80 patients requiring intestinal anastomosis were included in this study from October 2011 to October 2012. In this study 43 single layer extramucosal and 37 conventional double layered anastomosis were observed and Comparison was made in terms of time required for anastomosis, anastomotic leak and other complications, and the cost incurred. Single layer anastomosis was performed with a continuous 2-0 polyglycolic acid suture & two layer anastomosis was constructed using 2-0 silk lembert suture for the outer layer & a continuous 2-0 polyglycolic acid suture for inner layer. 80 patients were subjected to intestinal anastomsis either single or double layer in emergency or electively by senior surgeon (Registrar or consultant). In 43 cases single layer anastomsis was done (18 emergency + 25 elective). In 37 cases double layer anastomosis was done (14 in emergency + 23 elective). In our study single layer anastomosis took 16-22 minutes whereas double anastomosis took 26-36 minutes. The average postoperative stay in hospital was 11.45 days for single layer and 13.45 days for double layer. The study shows that there was low incidence of anastomotic failure and setpic complications in single layer as compared with the double conventional methods of gut anastomosis. Hence the single layer anastomosis is safe and cost effective.

Double layer versus Single layer Gastro-intestinal anastomosis in gastric cancer surgery in Mymensingh Medical College Hospital

Introduction: In gastric cancer surgery, gastrojejunostomy is one of the most important procedures. Anastomosis between different parts of the stomach and the intestine is a basic technical component in all gastrointestinal procedure. Backgrounds and aims: This study evaluated complications of gastrojejunostomy in gastric cancer surgery with two methods: single-layer and double-layer anastomosis. Materials and methods: This study was carried out in the department of surgery in Mymensingh Medical College Hospital from January 1, 2009 to December 31, 2012. 100 patients with carcinoma stomach who needed gastrojejunostomy were included in this study. These patients with average age of 43.22 years were divided in two groups (50 in each group); single-layer and double-layer anastomosis. In single-layer anastomosis gastrojejunostomy was performed in interrupted method with absorbable suture (2/0 vicryl). Double-layer anastomosis was carried out with continuous suture (2/0 silk, 2/0 catgut). Possible post-operative complications like anastomotic leakage, pelvic abscess, abdominal sepsis, anastomotic stenosis and wound infection were evaluated. Results: In the single-layer group, 4 patients (8%) developed anastomotic leakage, wound infection and only 2 patients (4%) developed abdominal sepsis, pelvic abscess and anastomotic bleeding. No patient developed anastomotic stricture. In double-layer group, 2 (4%) patients developed anastomotic leakage, only 1 (2%) patient had pelvic abscess, abdominal sepsis and anastomotic bleeding but wound infection in 2 (4%) patients. Conclusion: Gastrojejunostomy with single-layer hand-sewn suture technique is safe without serious complications in comparison to double-layer suture technique. More-over operation time is less and cost is less in single-layer method.DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16695 Community Based Medical Journal 2013 July: Vol.02 No 02: 30-34

Single Layered Intestinal Anastomosis: A Safe and Economic Technique

The objective of the study was to compare single-layered intestinal anastomosis and double-layered intestinal anastomosis in terms of safety and cost-effectiveness. A comparative prospective study was conducted in the Department of General Surgery, SSG Hospital, Baroda, from May 2007 to November 2009. All the patients above the age of 12years, requiring intestinal anastomosis in emergency or electively, were randomly assigned either of the group. Those requiring anastomosis to the stomach, or to the duodenum, or to the rectum were excluded. Single-layered anastomoses were constructed with a continuous 3-0 polypropylene suture. Double-layered anastomoses were constructed using interrupted 3-0 silk Lembert sutures for the outer layer and a continuous 3-0 polyglactin suture for the inner layer. Comparison was made in terms of time required for anastomosis, anastomotic leak and other complications, and the cost incurred. Seventy-three single-layered and 72 double-layered anastomoses were performed. Age and sex difference was not significant. The mean time required to construct single-layered anastomosis was 9.5min and that for double-layered anastomosis was 19.3min. Anastomotic leak and other complications were similar in both the groups. The length of hospital stay was also comparable. The expenditure for the procedure was significantly different (` 298 for single-layered anastomosis, whereas ` 390 for double-layered anastomosis). Single-layered intestinal anastomosis does not carry any increased risk of anastomotic leak when compared with the conventional double-layered technique, can be constructed in shorter time and at a lower cost.