Single-layer Intestinal Anastomosis Research Articles

Single-Layer or Double-Layer Intestinal Anastomosis: A Systematic Review of Randomized Controlled Trials.

Several malignant and benign indications may necessitate bowel resection. Despite the emergence of newer techniques, the hand-sewn technique remains popular for the reestablishment of intestinal continuity after resection. This method can achieve anastomosis in one or two layers. Some studies have suggested that the single-layer technique has several potential benefits compared to its rivals while simultaneously maintaining a comparable efficacy and safety profile. Previous reviews have failed to recommend either of these methods over the other due to a lack of high-quality evidence. This review aims to establish which technique provides the best outcomes by reviewing recent relevant trials and comparing both methods. We conducted a systematic review of randomized controlled trials (RCTs) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A database search of PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) ultimately returned nine randomized trials published between 2003 and 2023 comparing single-layer intestinal anastomosis (SLIA) and double-layer intestinal anastomosis (DLIA) that fit the inclusion criteria. Overall, results show a dearth of robust trials, and the included studies displayed variable eligibility criteria and materials used for anastomosis. The available evidence, however, does suggest that neither technique is inferior in terms of preventing post-operative complications, but SLIA is less expensive and quicker to perform. The evidence is, however, limited, and further high-quality research is needed.

COMPARATIVE STUDY OF SINGLE LAYER INESTINAL ANASTOMOSIS AND DOUBLE LAYER INTESINAL ANASTOMOSIS

Background: Gastrointestinal anastomosis is one of the most common procedures being performed in oesophagogastric, hepatobiliary, bariatric, small bowel and colorectal surgery. There are still conflicting views regarding suitability of single layer and double layer anastomotic technique. Methods: This comparative study was conducted at Patna Medical College and Hospital,Patna in which 48 patients were repaired with single layer anastomosis and 48 were repaired with double layer intestinal anastomosis. Single layer intestinal anastomosis was carried using extramucosal technique with 2-0 vicryl suture (round body). Double layer anastomosis was carried out using interrupted 2-0 vicryl suture for both inner (continuous) and outer ( Interrupted) layer.End to end colocolic,end to side ileocolic,end to end ileoileal,side to side ileoileal,end to end jejunoileal and end to end jejunojejunal anastomosis were performed. Each group was compared for anastomotic leak, time required to construct the anastomosis and length of hospital stay. Results: The mean time taken for anastomosis (15±2 minutes in single layer anastomosis versus 32±5 minutes in double layer) and the length of hospital stay was same in both the groups.There was 1 anastomosis leak in single layer anastomosis group and 3 in double layer group. Conclusion: 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.

COMPARATIVE STUDY BETWEEN SINGLE LAYER VERSUS DOUBLE LAYER ANASTOMOTIC TECHNIQUE FOR SMALL INTESTINAL ANASTOMOSIS IN ADULTS

Background: Anastomosis of gastrointestinal tract more commonly used in most of abdominal operations including esophagus, stomach, small intestine, large intestine, and biliary system. However single layer versus double layer anastomotic technique is still a matter of discussion as regard safety and efficacy. Objective: To study efficacy and safety of single layer intestinal anastomosis against double layer anastomosis as regard leakage, cost effectiveness, and the time of the procedure. Patients and methods: This prospective randomized study included 40 patients requiring small intestinal resection and anastomosis at Al- Hussein University Hospital and Damanhur Medical National Institute (Al-Behira) during the period between May 2019 and October 2020. The cases of this study were subjected to full history taking, full clinical examination, along with routine laboratory and radiological investigations. The cases of this study were divided into two equal groups randomly; Group A was subjected to one-layer anastomosis, and group B underwent double layered anastomosis. All cases were subjected to the standard post-operative care. Oral intake and hospital stay were recorded. In addition, post-operative complications including leakage, ileus, and mortality were recorded. Results: Mean time of operation in the single layer intestinal anastomosis was statistically significantly shorter as compared with double layered intestinal anastomosis (28.29 ± 8.15 minutes and 35.19 ± 9.96 minutes) respectively. The early postoperative findings and late postoperative complications were comparable in both groups with no statistically significant difference. Conclusion: Single layer intestinal anastomosis was less time consuming, less utilization of packing material, in addition to equal efficacy and safety as compared with double layer intestinal anastomosis.

A comparative study of suturing technique of intestine between extra-mucosal single layer interrupted and continuous all layers: a single center experience

Background: Gastrointestinal anastomosis has been excited interest in our day to day surgical practice. We have compared efficacy, advantages, disadvantages, and complications following intestinal resection-anastomosis using extra-mucosal interrupted single layer suturing or continuous all layer suturing.Methods: This comparative study included 50 cases (either in emergency or elective undergoing bowel resection and anastomosis), comprising of 2 Groups (25 cases in each Group) between January 2019 to June 2021 at Midnapore Medical College and Hospital. Patients data, operative findings, duration of anastomosis and length of hospital stay, post-operative complications of all patients were followed till discharge.Results: Our comparative study have shown that- the mean duration for intestinal anastomosis in Group A (extra-mucosal interrupted single layer) and Group B (continuous all layers) were 21.43 minutes and 14.35 respectively. Considering duration of the anastomosis continuous all layers intestinal anastomosis appears to represent in shorter duration, anastomotic leak was noted in 3 patients (6%). Anastomotic leak was observed in 1 patient extra-mucosal interrupted single layer bowel anastomosis whereas two patients in the Group of continuous all layered bowel anastomosis had leak (p value 0.5-not significant) and the mean duration of hospital stay in the Group A and Group B were 7.32 days and 7.92 days respectively. (p value -insignificant).Conclusions: Duration required to perform a continuous all layer bowl anastomosis is lesser when compared to an extra-mucosal interrupted single layer intestinal anastomosis. There is no significant difference in complications, final outcome and duration of hospital stay between two Groups.

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

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.

Single layer extramucosal versus double layer anastomosis for colostomy closure in children with anorectal malformation

Background: Intestinal anastomosis is one of the commonly performed procedure in gastrointestinal surgeries. The purpose of this study is to Assess safety, efficacy, cost effectiveness of single layer anastomosis over double layer anastomosis for colostomy closure in children with Anorectal Malformation at tertiary care centre. Materials and Methods: This prospective observational comparative study conducted between February 2016 to January 2021 consisting of 47 patients. All the children admitted for colostomy closure after definitive staged procedure for anorectal malformation were enrolled in the study. All anastomoses were of end-to-end type. The single layered anastomoses were performed by using interrupted 3-0 polydioxanone suture beginning at the mesenteric border and taking all layers of bowel wall except the mucosa into the bite. The double layered anastomoses were performed using interrupted 3-0 polydioxanone suture for the transmural inner layer and interrupted 3-0 polydioxanone Lembert sutures for outer seromuscular layer. Outcome parameters assessed were, quantity and cost of suture material used, time taken for anastomosis, time taken for surgery, postoperative return of peristalsis and passage of flatus, postoperative complications like paralytic ileus, bowel obstruction, anastomotic dehiscence diagnosed by presence of enteric contents like bile or faeces in drain or wound or diagnosed on radiological imaging like CT scans and hospital stay. Data were recorded in the case record form. Qualitative data was expressed in terms of proportions. Quantitative data was expressed in terms of Mean and Standard deviation. All the data collected was analysed by using SPSS 24.0 version IBM USA. Results: Out of total 47 children enrolled in study, 25 (53.19%)children were allocated to single layered extra mucosal intermittent anastomosis and 22 (46.81%) children to double layered anastomosis. All children admitted for colostomy closure had age ranges between 7 months to 36 months with mean age of 11.5 ±3.8 months.Amongst all the children undergoing anastomosis 35(74.47%) were males and 12(25.53%) were females. Observed outcome parameters like mean time taken for surgery in minutes (120.4±15.3 Vs 135.7±12.5), mean time taken for anastomosis in minutes (15.1±2.3 Vs 24.4±2.3), mean day of return of bowel sounds on postoperative day (2.40 Vs 3.74), mean day of first postoperative bowel movement (3.41 Vs 4.89 ) were significantly less in single layer anastomosis group than in double layer anastomosis. Suture material used in single layer anastomosis was lesser in quantity than used in double layer anastomosis. Post-operative complications were seen in 3 (06.38%) children of in single layer anastomosis group and 5 (10.63%) children of double layer anastomosis group. One child who underwent double layer anastomosis had anastomosis leak while none of child in single layer anastomosis group had leak. Mean duration of hospital stay was 5.95±1.40 days in single layer anastomosis group which is lesser than mean duration of hospital stay of 7.45 ± 1.95 days in double layer anastomosis group. Conclusion: Single layer intestinal anastomosis resulted in significant reduction in operative time, hastens the postoperative recovery of bowel function, reduces suture material, hospital stay and cost; without any difference in complications.

Single layer versus double layer intestinal anastomoses: a comparative study

Background: There are still conflicting views regarding suitability of single layer and double layer anastomotic technique. This prospective single blinded randomized comparative study conducted at Rajendra Institute of Medical Sciences to assess various aspects viz. safety, efficacy, duration of hospital stays and chances of perforation in single- and double-layer anastomotic surgery.Methods: 26 patients each in single layer and double layer anastomosis group were included in the study. Single layer intestinal anastomosis was carried using extramucosal technique with 2-0 vicryl suture (round body). Double layer anastomosis was carried out using interrupted 3-0 silk lembert sutures for the outer layer and a continuous 2-0 vicryl for the inner layer. End to end colocolic, end to end ileocolic, end to side ileocolic, end to end ileoileal, side to side ileoileal, end to end jejunoileal and end to end jejunojejunal anastomosis were performed. Each group was compared for anastomotic leak, time required to construct the anastomosis, cost incurred, and length of hospital stay.Results: Findings of the study indicated that single layer is economical in comparison to double layer anastomosis and took significant less time to operate. There was no significant difference in hospital stay of the patients in two groups. There was no anastomotic leak in group-S (single layer) while one (3.8%) patient in group-D (double layer) suffered from anastomotic leak.Conclusions: It was concluded that single layer anastomosis method is beneficial and safe as it required less operative time, suturing material and no leak took place after surgery.

A commentary on “Efficacy of single layered intestinal anastomosis over double layered intestinal anastomosis - An open labeled, randomized controlled trial” - What is missing for a careful analysis? The importance of considering all the factors involved

A commentary on “Efficacy of single layered intestinal anastomosis over double layered intestinal anastomosis - An open labeled, randomized controlled trial” - What is missing for a careful analysis? The importance of considering all the factors involved

Efficacy of single layered intestinal anastomosis over double layered intestinal anastomosis-an open labelled, randomized controlled trial.

The hand-sewn method of bowel anastomosis is the most common because of its affordability, familiarity and easy availability of materials. It can be done in single or double layers, with different surgeons preferring one technique over the other. Double layer intestinal anastomosis (DLIA) is time-consuming, challenging to perform, and carries possibly a higher risk of devascularisation, infection, and necrosis. Studies conducted so far do not show a significant difference between the two, but have concluded that more studies are required to determine this definitively. This study attempted to see whether the single layer intestinal anastomosis (SLIA) is non-inferior to DLIA in terms of incidence of anastomotic leak. It also compared mortality, morbidity, and length of hospitalization (LOH) between the two groups. This was a parallel arm, open labelled, non-inferiority randomized controlled trial conducted in the department of surgery in a tertiary care centre between October 2016 and March 2018. Patients who fulfilled the inclusion criteria were randomly allotted to two groups: Patients undergoing SLIA and patients undergoing DLIA. After the procedure, all patients were assessed for anastomotic leak, morbidity, mortality and LOH in the postoperative period. A 3-month follow-up period was observed for complications. A total of 106 patients were randomised, 52 in SLIA and 54 in DLIA. Baseline demographic and clinicopathological characteristics between the two groups were comparable. The most common indication for intestinal anastomosis was ostomy closure in both groups. There was no significant difference between the two groups in terms of anastomotic leak, other complications, mortality and LOH. SLIA was comparable to DLIA with respect to incidence of anastomotic leak, morbidity, mortality, and the length of hospitalization, and can be considered as a safe and feasible alternative, in elective and emergency settings.

A Prospective Comparative Study of Intestinal Anastomosis, Single Layer Extramucosal Versus Double Layer

Background Intestinal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel. The technique for stoma reversal has remained controversial in the use of single layer or two layers of anastomosis. Method 30 patients for stoma closure were taken for study. These patients divided in two groups A and B, 20 and 10 each. These patients were taken up for ileostomy closure in single layer group A n-20 & double layer group B n-10. Results 30 Patients of ileostomy were studied, divided in 2 groups, both groups were found to be comparatively equal in outcome with no any significant difference in complications. Conclusion Double-layer anastomosis for ileostomy closure offers no definite advantage over single layer anastomosis in terms of postoperative leak and other complications. Single layer ileostomy closure technique is safe, easy to perform and simply to taught. Considering duration of the closure procedure and cost benefits, single-layer intestinal anastomosis may prove the choice of procedure for most of the surgeons

Su2064 – Efficacy of Single Layered Intestinal Anastomosis Versus Double Layered Intestinal Anastomosis- an Open Label Randomized Controlled Trial

Su2064 – Efficacy of Single Layered Intestinal Anastomosis Versus Double Layered Intestinal Anastomosis- an Open Label Randomized Controlled Trial

A Prospective Comparative Study of Intestinal Anastomosis, Single Layer Extramucosal Versus Double Layer

Background Intestinal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel. The technique for stoma reversal has remained controversial in the use of single layer or two layers of anastomosis. Method 30 patients for stoma closure were taken for study. These patients divided in two groups A and B, 20 and 10 each. These patients were taken up for ileostomy closure in single layer group A n-20 & double layer group B n-10. Results 30 Patients of ileostomy were studied, divided in 2 groups, both groups were found to be comparatively equal in outcome with no any significant difference in complications. Conclusion Double-layer anastomosis for ileostomy closure offers no definite advantage over single layer anastomosis in terms of postoperative leak and other complications. Single layer ileostomy closure technique is safe, easy to perform and simply to taught. Considering duration of the closure procedure and cost benefits, single-layer intestinal anastomosis may prove the choice of procedure for most of the surgeons

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-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

Extramucosal single layer interrupted intestinal anastomosis - a better alternative

Objectives: To evaluate the technique of extra mucosal interrupted single layer intestinal anastomosis in different diseases where anastomosis is needed in different parts of gastrointestinal tract both in elective and emergency situations. Design: Prospective study. Place and Duration of Study: Surgical Unit 1 Jinnah Hospital Lahore, over a period of 2`/2 years from December 2000 to June 2003. Material and Methods: In this study 123 anastomosis were performed in 100 patients. All these patients were operated upon by the senior surgeons in the emergency/elective operating rooms. Single layer interrupted extramucosal anastomosis with vicryl 2/0 or 3/0 was done in all cases. Results: Overall anastomotic leak was just 0.81%. Wound infection was observed in 6%, without any increase in morbidity and zero percent mortality. Conclusion: Extramucosal single layer interrupted intestinal anastomosis is the safest technique both for the small and large bowel, with minimal possible complications.

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

A comparative study between single layer versus double layer closure in ileostomy reversal

Background: Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel. The technique for stoma reversal has remained controversial is the use of either one or two layers of sutures for anastomosis.Methods: Sixty patients with ileostomy were taken for study .These patients divided in two groups A and B, 30 each. These patients were taken up for ileostomy closure in single layer (group A) (n-30) &double layer (group B) (n-30). Results: 60 Patients of ileostomy were studied, divided equally in 2 groups, A decreased intra operative time was seen in Group A when compared with Group B with no any significant comparative complication in these groups. Conclusion: Two-layer anastomosis for ileostomy closure offers no definite advantage over single layer anastomosis in terms of postoperative leak and other complications. Single layer ileostomy closure technique is safe, easy to perform and simply to taught. Considering duration of the anastomosis procedure and medical expenses single-layer intestinal anastomosis may prove the choice of procedure for most of the surgeons. DOI: http://dx.doi.org/10.3126/ajms.v6i2.10080Asian Journal of Medical Sciences Vol.6(2) 2015 44-47

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.

Comparision of single and double layer intestinal anastomosis in Ahwaz educational hospitals (2005-2006)

Backgrounds and aim: This study evaluated complications of intestinal anastomosis in urgent and elective patients with two methods: singleor double-layer anastomosis.Patients and methods: This case-control study was carried out from July 1, 2005 to Aug 31, 2006 (14 months) in 3 university hospitals. Patients who had an indication for intestinal anastomosis (urgent or elective) were included. In this study, 126 patients with an average age of 31.39±21.08 years were divided into two groups: single-layer (63 patients) and double-layer (63 patients) intestinal anastomosis. In the single-layer group, intestinal anastomosis was carried out in continuous or interrupted method with absorbable or non-absorbable suture. Double-layer anastomosis was carried out in internal layer with continuous suture and external layer with interrupted suture. Post-operation complications were evaluated for fistula, wound infection, intra-abdominal abscess and stricture of anastomosis site. All intestinal anastomoses were carried out with the hand-sewn method.Results: In single-layer intestinal anastomosis, 5 patients (7.9%) had wound infection, 2 patients (3.2%) intra-abdominal abscess and one patient (1.6%) enterocutaneous fistula, and in the two-layer group, 7 patients (11.1%) had wound infection, 2 patients (3.2%) intra-abdominal abscess and 4 patients (6.3%) fistula. No patient experienced stricture of the intestinal anastomosis site.Conclusion: Single-layer anastomosis is safe. Complications of singleor double-layer anastomosis were similar. In addition, we have decreased operation time and total cost by the single-layer method.

Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials

BackgroundTo compare single- with two- layer intestinal anastomosis after intestinal resection: a meta-analysis of randomized controlled trials.MethodsRandomized controlled trials comparing single- with two-layer intestinal anastomosis were identified using a systematic search of Medline, Embase and the Cochrane Library Databases covering articles published from 1966 to 2004. Outcome of primary interest was postoperative leak. A risk ratio for trial outcomes and weighted pooled estimates for data were calculated. A fixed-effect model weighted using Mantel-Haenszel methods and a random-effect model using DerSimonian-Laird methods were employed.ResultsSix trials were analyzed, comprising 670 participants (single-layer group, n = 299; two-layer group, n = 371). Data on leaks were available from all included studies. Combined risk ratio using DerSimonian-Laird methods was 0.91 (95% CI = 0.49 to 1.69), and indicated no significant difference. Inter-study heterogeneity was significant (χ2 = 10.5, d.f. = 5, p = 0.06).ConclusionNo evidence was found that two-layer intestinal anastomosis leads to fewer post-operative leaks than single layer. Considering duration of the anastomosis procedure and medical expenses, single-layer intestinal anastomosis appears to represent the optimal choice for most surgical situations.