Single-layer Anastomosis Research Articles

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

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

Emergency Ileo-cecal Anastomosis with Inclusion of Appendicular Stump in Terminal Ileal Pathology: A Newer Approach.

Background:In emergency settings, several surgical procedures are described while dealing with pathology of terminal ileal lying within 15 cm of the ileocecal valve, but there is still confusion and controversy over the optimal surgical treatment.Methods:A nonrandomized study of 210 patients with near terminal ileal pathology (within 15 cm) was carried out over a period of 10 years. The study included 112 cases in which an ileocecal anastomosis with inclusion of appendicular stump was used in terminal ileal pathologies, and in rest 98 cases, other surgical procedures were used. The outcomes were measured in relation to postoperative complications and mortality.Results:Postoperative complications encountered in emergency ileocecal anastomosis with the inclusion of appendicular stump were wound infection in 31 patients (34.72%), respiratory complications in 10 patients (11.2%), septicemia in 6 patients (6.72.%), and anastomotic leak in one patient (1.12%).Conclusion:The technique of ileocecal single-layer anastomosis with the inclusion of appendicular stump was found to be very effective in dealing this common problem and had less morbidity and mortality.

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

Role of diclofenac sodium and paracetamol on colonic anastomosis: An experimental rodent model

Despite many advances in surgery and technology, colonic anastomosis remains a challenge after colonic resection. The purpose of this study is to compare the safety of using diclofenac sodium and paracetamol for analgesia in colonic anastomosis on rats. Wistar-Hannover rats were randomly allocated to four groups: Group 1, sham-operated group; Group 2, control group; Group 3, diclofenac sodium group; Group 4, paracetamol group. After laparotomy, the left colon was transected and a single-layer anastomosis was made with 5/0 vicryl in Groups 2, 3, and 4. Only laparotomy was performed in Group 1. After anastomosis, we administered saline to Group 2, diclofenac sodium to Group 3, and paracetamol to Group 4 for 7 days. Then, all animals were decapitated. The anastomotic region was resected, and bursting pressure was measured. Then, the specimen was sent to the laboratory for histological examination and hydroxyproline analysis. Bursting pressure and hydroxyproline level were significantly higher in the paracetamol group (p<0.05). When we looked at the fibrosis levels of these groups, it was also higher in paracetamol group. Bursting pressure, hydroxyproline levels, and fibrosis levels indicate that the perioperative use of paracetamol for analgesia when undergoing colonic anastomosis is safer than diclofenac sodium.

The Effect of a Synthetic Heparan Sulfate on the Healing of Colonic Anastomoses.

Background The mimetic compound OTR4120 may replace endogenous-degraded heparan sulfates that normally maintain the bioactivity of growth factors that are important for tissue repair. Herein, we investigated the effect of OTR4120 on the healing of normal colonic anastomoses. Methods We evaluated the following two treatment groups of male Sprague Dawley rats (220–256 g): control-treated colonic anastomoses (n = 25) and OTR4120-treated colonic anastomoses (n = 25). We resected 10 mm of the left colon and then applied either saline alone (control) or OTR4120 (100 μg/mL) in saline to the colonic ends before an end-to-end single-layer anastomosis was constructed and again on the anastomosis before the abdomen and skin were closed. Results On postoperative day 3, the anastomotic breaking strengths were 1.47 ± 0.32 N (mean ± SD) in the control group and 1.52 ± 0.27 N in the OTR4120-treated animals (P = 0.622). We also found that the hydroxyproline concentration (indicator of collagen) in the anastomotic wounds did not differ (P = 0.571) between the two groups. Conclusions Our data demonstrate that a single local application of OTR4120 intraoperatively did not increase the biomechanical strength of colonic anastomoses at the critical postoperative day 3 when the anastomoses are the weakest.

A Comparison between Two Kidney Transplant Ureteroneocystostomy Techniques: Full-Thickness Single Layer Anastomosis and Lich-Gregoir

Urinary complications such as urine leak, stricture, ureteric obstruction and vesicoureteral reflux are the most common technical adverse events following A variety of urinary tract reconstructive methods have been proposed and compared to find an ideal method with minimum urinary complications. Today, ureteroneocystostomy is the most common urinary tract reconstructive method utilized in kidney transplantation. The main aim of the present study was to compare urologic complications following the use of FTSL and LG techniques in kidney transplant ureteroneocystostomy in a clinical trial study.

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

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.

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) &amp;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-layer seromuscular Continuous Versus Two-Layers Intestinal Anastomosis Of Small bowel in Baghdad Teaching Hospital (A prospective Study)

Background: Anastomosis may be done with the help of stapling devices, by using double layered suturing technique or by a single layer technique.Patients and methods: A prospective study conducted in Baghdad Teaching Hospital, Iraq. A total of sixty- four patients were included in this study. They were divided into two groups; group A, 28 patients, single layer seromuscular continuous anastomosis was done and group B, 36 patients underwent conventional double layered anastomosis.Objective: The aim of the study is to prove that a single layer continuous technique can be constructed in a significantly less time with similar rate of complications compared with two layers technique.&#x0D; Results: There were, 15 male (53.6%) and 13 (46.4%) female within group A and 20 (55.6%) male and 16 (44.4%) female within the group B. There was no significant difference in gender distribution or mean age between or within groups. Bullet and sharp nail injuries to the abdomen were the most common causative agents followed by malignant disease of GIT. Wound infection was the most frequent complication in both groups as fourteen patient out of 64 (21.9%) developed wound infection; 8 of them were among group B. There was no significant difference in the incidence of anastomotic leakage; in group A was 3.6%, while in group B was 4.7%. The average time for the construction of the single layer anastomosis was 20 min and in double layer it was 35 min. The difference in average time is statistically significant&#x0D; Conclusion: The single-layer continuous anastomosis requires less time to construct and has a similar risk of leakage compared with the two-layer technique. It also costs less than any other method and can be safely introduced into a surgical training program.

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.

Pyeloplasty in children by lumbotomy approach using infant feeding tube as single stent

The objective of this study was to assess the outcome in children who had undergone pyeloplasty by lumbotomy approach using infant feeding tube (IFT; 5 Fr) as a single stent. During January 2000 and December 2010, 134 pyeloplasty were performed by the lumbotomy approach. The procedure involves single layer anastomosis at pelvi-ureteric junction using vicryl 5-0/6-0 (reduction of pelvis if required). An IFT 5 Fr with multiple holes used as a single stent to serve as nephrostomy and as transanastomotic stent also. There were 109 males and 25 females with M: F ratio of 4.3:1. Left-side pelvi-ureteric junction obstruction (PUJO) was seen in 117 (87.3%) while right side PUJO in 17 (12.7%). Mean age of presentation was 52.7 months (range 9-120 months). Postoperative complications included infection 2 (1.5%), urinoma formation 1 (0.7%), urine leak 3 (2.2%), non drainage 2 (1.5%), accidental removal of the stent 2 (1.5%). Follow-up scan done at 3 and 9 months showed improved drainage in 124 (92.5%), preserved renal function in 129 (96.2%) cases. Overall success rate 97.5%. Transanastomotic stent using IFT not only provide an effective drainage but also avoid the complications associated with double-J stents and nephrostomies, with the added benefit of being cheaper and availability.

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.

Esophageal atresia

Introduction and aim The aim of this study was to compare the type of suture, technique of suture, and technique of anastomosis between survivors and mortality cases. Patients and methods This study was conducted in Bahrami Hospital and Children’s Medical Center on cases with esophageal atresia who underwent surgery for esophageal atresia and/or tracheoesophageal fistula repair. The places of study were Bahrami Hospital and Children’s Medical Center, two referral centers for pediatric surgery in Tehran. The duration of the study was 2 years, starting from April 1999. Survivors and mortality cases were compared with regard to sex, type of surgery, suture material, and technique of anastomosis. Gross classification was used for typing of anomaly. All data were analyzed again using SPSS ver. 13.0 and Epi-info ver. 6.04d (CDC,WHO). The v2-test was used for comparison. Results In this study, 21 (male = 9, female =12) mortality cases and 53 (male = 29, female =24) survivors were included. Among them, 18 (85.7%) mortality cases and 51 (96.2%) survivors had type C atresia (P = 0.23). Thoracotomy and repair of atresia was performed in 10 (47.6%) mortality cases and 51 (96.2%) survivors. Gastrostomy and tracheoesophageal fistula repair was performed in eight (38.1%) mortality cases. Gastrostomy and cervical esophagostomy was performed in three (14.7%) mortality cases and two (3.8%) survivors. Anastomotic leak was noted in eight mortality cases and 10 survivors who underwent thoracotomy and atresia repair (P = 0.0005). End-to-end anastomosis was performed for nine mortality cases and 45 survivors (P = 0.7). Extrapleural thoracotomy was performed in nine mortality cases and 45 survivors (P = 0.7). Single-layer anastomosis was performed in eight mortality cases and 36 survivors (P = 0.82). There were no significant differences between survivors and mortality cases with regard to sex and type of atresia (P =0.23). Thoracotomy and atresia repair was more frequently performed in survivors than in mortality cases (P = 0.000004). Anastomotic leakage was significantly higher in mortality cases compared with survivors (P = 0.0005). Conclusion Anastomosis leakage was associated with higher mortality. The rate of thoracotomy and atresia repair surgery is higher in survivors compared with mortality cases. Keywords : esophageal atresia, risk factors, surgical repair

Single layer versus double layer suture anastomosis of the gastrointestinal tract

Gastrointestinal anastomosis (GIA) is an essential step to maintain the continuity of gastrointestinal tract following intestinal resection. GIA is still a source of significant controversy among surgeons due to the use of variety of approaches. Adequate apposition by single layer or double layer anastomosis may affect outcome after GIA OBJECTIVES: The objective of this review is to compare the effectiveness of single layer GIA (SGIA) versus double layer GIA (DGIA) being used in general surgery. The particular question we would attempt to answer will be; is single layer hand made GIA in surgical patients is as effective as double layer? The CCCG (Colorectal Cancer Cochrane Group) Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2011), MEDLINE (until April 2011) , EMBASE ( The Intelligent Gateway to Biomedical & Pharmacological Information until April 2011), LILACS (The Latin American and Caribbean Health Sciences Library until April 2011 ) and Science Citation Index Expanded (SCI-E until April 2011) using the medical subject headings (MeSH) terms were searched without date, language or age restrictions. Randomised, controlled trials comparing the effectiveness of SGIA versus DGIA DATA COLLECTION AND ANALYSIS: At least two review authors independently scrutinised search results, selected eligible studies and extracted data. Seven randomised, controlled trials encompassing 842 patients undergoing SGIA versus DGIA were retrieved from the electronic databases. There were 408 patients in the SGIA group and 432 patients in the DGIA group. All included studies were small, with sample sizes ranging from 60 to 172. There was no heterogeneity among the included trials. Therefore, in the fixed effects model, incidence of anastomotic dehiscence, peri-operative complications and mortality was statistically equivalent between two techniques of GIA. Average hospital stay following SGIA and DGIA was also comparable. However, SGIA was superior in terms of shorter operative time. Sensitivity analysis of relatively good quality and poor quality trials supported same conclusion. SGIA can be performed quicker as compared to double layer GIA. SGIA is comparable to DGIA in terms of anastomotic leak, peri-operative complications, mortality and hospital stay. SGIA may routinely be used for GIA following bowel resection. However, since this conclusion is derived from smaller number of patients recruited in relatively moderate quality trials, further trials should be aimed to reduce the limitations of this review.

Analysis of Risk Factors for Delayed Gastric Emptying (DGE) after 387 Pancreaticoduodenectomies with Usage of 70 Stapled Reconstructions

BackgroundDelayed gastric emptying (DGE) is one of the most troublesome complications after pancreaticoduodenectomy (PD). MethodsBetween 2004 and 2009, 387 patients underwent PD and of these, 302 patients (78%) underwent pylorus-preserving PD. The stapled reconstruction of duodeno- or gastrojejunostomy was introduced in 2006, and 70 patients (18%) underwent stapled Roux-en-Y reconstruction. Postoperative DGE was defined based on the International Study Group on Pancreatic Surgery classification, and grade B or C DGE was considered to be clinically relevant. Risk factors for DGE were evaluated using univariate and multivariate analyses. ResultsFour patients died in the hospital (1.0%). Postoperative DGE was found in 70 patients (18%). DGE was less frequently seen in stapled reconstruction than in hand-sewn reconstruction (7.2% vs. 21%, P < 0.001), and in single-layer anastomosis than in double-layer anastomosis (12% vs. 24%, P = 0.02). The multivariate logistic regression analysis revealed that the independent risk factors for DGE were postoperative pancreatic fistula (risk ratio [RR] 2.4, P = 0.002), hand-sewn reconstruction (RR 2.9, P = 0.03) and male (RR 2.2, P = 0.02). ConclusionThe method of alimentary reconstruction affected the occurrence of DGE. The incidence of DGE was less in stapled reconstruction than in hand-sewn reconstruction.

Ex vivo comparison of three hand sewn end‐to‐end anastomoses in normal equine jejunum

Although single layer techniques are preferred in man and small animals for small intestinal end-to-end anastomoses, double layer techniques are more popular in equine surgery. This study was undertaken to evaluate the ex vivo characteristics of 2 single layer anastomoses in comparison to the traditionally performed double layer anastomosis in equine jejunum. To compare ex vivo: 1) construction time; 2) bursting pressure; and 3) lumen size reduction of 3 suture patterns (double layer simple continuous/Cushing pattern [2C]; single layer Lembert pattern [1L]; and single layer Cushing pattern [1C]) for end-to-end equine jejunojejunostomies. End-to-end jejunojejunostomies were constructed using 2C (n = 7), 1L (n = 7) and 1C (n = 7) in harvested equine jejunum and construction times were recorded. Anastomosed and control segments were distended with gas until failure. Intraluminal pressure at failure and mode of failure were recorded. Lumen size reduction was calculated as a percentage decrease from control jejunum. Results were compared using an ANOVA and P<0.05 was considered significant. The 1C anastomoses were faster to construct than the 1L anastomoses, which were faster to construct than the 2C anastomoses. There were no differences in bursting pressures between the different anastomoses and control jejunum. All anastomoses decreased lumen size from control values but there were no differences in lumen reduction between types of anastomoses. Single layer anastomoses are faster to construct than double layer anastomoses, with the 1C being fastest. Single layer anastomoses are as strong and result in comparable lumen size reduction as traditional 2C anastomoses. As the 1C anastomosis results in less exposed potentially adhesiogenic suture material than the 1L while providing adequate strength and similar luminal size reduction, the 1C may be better for equine small intestine anastomosis and further in vivo studies are warranted.