Single Layer Versus Double Layer Anastomosis of Small Intestine – A Comparative Study from Karnataka, India

BACKGROUND Intestinal anastomosis is an operative procedure that is of importance in the practice of surgery. It is a very commonly performed technique in today’s surgical era. We wanted to study the postoperative complications like anastomotic leak and abscess formation and duration of hospital stay in single layer and double layer anastomosis and compare the same. METHODS In our prospective observational study, 80 patients were reviewed and were divided into 2 groups. Cases were allotted to either group based on the odd even method requiring single- and double-layer anastomosis, odd being single layer and even being double layer anastomosis. Intestinal anastomosis was carried out in single layer technique with delayed absorbable suture material and double layer technique with inner transmural layer with delayed absorbable suture material and seromuscular layer with non-absorbable suture material. RESULTS Each group had 40 patients, there was significant difference noted between the groups. Mean duration of hospital stay in single layer group was 17.85 ± 7.62 days and in double layer group was 26.20 ± 16.12 days (P = 0.043 *). In single group, mean time taken for anastomosis was 18.50 ± 1.73 and in double group was 29.05 ± 2.19. There was significant difference in time taken between two groups (P < 0.001). In single group, majority of subjects had no anastomotic Leak (95 %) and 5 % had leak. In double group 70 % had no leak and 30 % had leak. P value was statistically significant (P = 0.037). CONCLUSIONS Single layer anastomosis was better in terms of duration of hospital stay, postoperative anastomotic leaks and time taken for anastomosis. KEY WORDS Single Layer, Double Layer, Small Bowel, Duration of Hospital Stay, Anastomotic Leaks

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Single Layer Extra-Mucosal Versus Double Layer Intestinal Anastomosis for Colostomy Closure: A Prospective Comparative Study

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v17i2.274 ◽

2021 ◽

Vol 17 (2) ◽

pp. 95-99

Author(s):

Layth Saleh Owaid ◽

Imad Wajeeh Al-Shahwani ◽

Zuhair B. Kamal ◽

Laith Naif Hindosh ◽

Abbas Farman Abdulrahman ◽

...

Keyword(s):

Double Layer ◽

Intestinal Anastomosis ◽

Single Layer ◽

Anastomosis Group ◽

Duration Of Hospital Stay ◽

Group A ◽

The Mean ◽

Group B ◽

Mean Cost ◽

Mean Time

Background: The main objective was to compare the outcome of single layer interrupted extra-mucosal sutures with that of double layer suturing in the closure of colostomies. Subjects and Methods: Sixty-seven patients with closure colostomy were assigned in a prospective randomized fashion into either single layer extra-mucosal anastomosis (Group A) or double layer anastomosis (Group B). Primary outcome measures included mean time taken for anastomosis, immediate postoperative complications, and mean duration of hospital stay. Secondary outcome measures assessed the postoperative return of bowel function, and the overall mean cost. Chi-square test and student t-test did the statistical analysis.. Results: Thirty-two patients were allocated to group A and 35 patients to group B. The mean time taken for anastomosis was significantly shorter in group A (23.25 ± 1.20 min in group A vs. 36.71 ± 1.93 min in group B; P<0.001). A significant shorter duration of hospital stay was seen in group A (7.00 ± 1.778 days in group A vs. 9.74 ± 1.990 days in group B; P<0.001). The detection of bowel sound was substantially quicker in group A as compared to group B (4.56 ± 0.50 days in group A vs. 6.46±0.50 days in group B; P<0.001). There was no significant discrepancy between the two groups regarding anastomotic leak rates (P= 0.543). The mean cost of double layer intestinal anastomosis method was significantly higher than that of single layer anastomosis (P<0.001). Conclusions: The use of single layer extra-mucosal anastomosis of the intestine has the advantage of taking less time, less morbidity and cost-effective to perform with the same rate of anastomotic leak in the closure of colostomy.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20213181 ◽

2021 ◽

Author(s):

Arvind Rai ◽

Sukantth R. J.

Keyword(s):

Anastomotic Leak ◽

Double Layer ◽

Statistical Tests ◽

Intestinal Anastomosis ◽

Single Layer ◽

Layer Versus ◽

Intestinal Anastomoses ◽

Significant Difference ◽

Group A ◽

Group B

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.

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An observational comparative study of single layer continuous extramucosal anastomosis versus conventional double layer intestinal anastomosis

International Surgery Journal ◽

10.18203/2349-2902.isj20205363 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4101

Author(s):

Suchin S. Dhamnaskar ◽

Anil Baid ◽

Nishant Gobbur ◽

Pratik Patil

Keyword(s):

Double Layer ◽

Suture Material ◽

Statistical Significance ◽

Intestinal Anastomosis ◽

Single Layer ◽

Bowel Function ◽

Anastomotic Dehiscence ◽

Postoperative Recovery ◽

Continuous Method ◽

Chi Square

Background: Conventional double layered technique of intestinal anastomosis are widely in practise. Some surgeons also practice single layer technique either continuous or interrupted. This was a prospective observational study to compare safety, efiicacy and feasibility of single versus double layered continuous techniques.Methods: Patients undergoing intestinal anastomosis with either of these two techniques were observed prospectively for various outcome parameters like length of suture material used, time taken for anastomosis, and that for entire surgery, postoperative complications, return of bowel activity etc. Data such obtained was analysed for statistical significance by applying chi-square test and unpaired ‘t’ test.Results: Length of suture used for single layer (mean of 15.06 cm) was statistically significantly lesser than that for double layer (mean 19.90 cm) (p.0.001). Time taken for anastomosis and overall surgical time too was significantly less for single layer group (p.0.001 and 0.022 respectively). Complications including anastomotic dehiscence were not significantly different between two groups. Postoperative recovery of bowel function was earlier in single layer group with marginal statistical significance (p=0.048).Conclusions: Thus in our study, single layer continuous method of intestinal anastomosis resulted in significant reduction in time, suture material length and cost; without any difference in complications and it marginally hastens the postoperative recovery of bowel function. So single layer continuous method can be recommended for intestinal anastomosis.

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Single layer versus double layer intestinal anastomoses: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20203782 ◽

2020 ◽

Vol 7 (9) ◽

pp. 2991

Author(s):

Ajit Kumar ◽

Vinod Kumar

Keyword(s):

Comparative Study ◽

Anastomotic Leak ◽

Double Layer ◽

Intestinal Anastomosis ◽

Single Layer ◽

Anastomosis Group ◽

Layer Versus ◽

Intestinal Anastomoses ◽

Significant Difference ◽

End To End

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.

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A COMPARATIVE STUDY BETWEEN SINGLE LAYER VERSUS DOUBLE LAYER INTESTINAL ANASTOMOSIS

10.36106/pijr/5702440 ◽

2021 ◽

pp. 64-66

Author(s):

Sudhansu Sarkar ◽

Sourav Das

Keyword(s):

Comparative Study ◽

Double Layer ◽

Intestinal Anastomosis ◽

Single Layer ◽

Layer Versus ◽

Medical College ◽

Number Of Patients ◽

Significant Difference ◽

Group A ◽

Group B

A comparative study between Single Layer versus Double Layer Intestinal Anastomosis,was undertaken at Department of Surgery,Bankura Sammilani Medical College & Hospital,Bankura from April 2019 – September 2020,which included 74 patients, comprising 2 groups: Group A-Single layer and Group B- Double layer with equal number of patients randomly allotted in each group. More number of patients had anastomotic leak in Group B than Group A, though not statistically significant. Difference of Mean Duration of Anastomosis with both groups is statistically significant.Mean Duration of Hospital Stay with both groups is statistically insignificant. Although more number of patients had anastomotic leaks in Group B than Group A,it was statistically insignificant.

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A comparative study of single layer extra mucosal versus conventional double layer anastomosis of intestines in elective and emergency laparotomy

International Surgery Journal ◽

10.18203/2349-2902.isj20195966 ◽

2019 ◽

Vol 7 (1) ◽

pp. 184

Author(s):

K. Lohit Sai ◽

C. Sugumar

Keyword(s):

Comparative Study ◽

Hospital Stay ◽

Anastomotic Leak ◽

Double Layer ◽

Single Layer ◽

Duration Of Hospital Stay ◽

Key Skills ◽

Group A ◽

The Difference ◽

Group B

Background: Gastrointestinal anastomosis has been a part of research since decades and is one of the key skills in surgeon’s armamentarium. This study compared the outcome of single layer anastomosis with double layer anastomosis.Methods: The study was designed as a prospective comparative study and 29 cases were included in the study during December 2016 to September 2017, who consented for being part of the study. Patients were alternatively allotted into the either group. Group A underwent single layer anastomosis and Group B underwent double layer anastomosis. Outcome parameters were analysed in the form of ‘duration required to perform anastomoses, ‘duration of hospital stay’ and ‘dnastomotic leak.Results: Mean duration required to perform anastomosis in Group A is 21.64±1.60 minutes and in Group B is 29.6±2.02 minutes. The difference between the mean duration required for anastomosis between the two groups were statistically significant (p<0.005). Mean duration of hospital stay in Group A was 12.35±1.72 days and Group B was 12±2.44 days (difference was statistically insignificant), 3 (10%) cases in Group A and 2 (6.8 %) cases in Group B developed anastomotic leak and the difference was statistically insignificant.Conclusions: Our study concluded that there is statistically significant difference between the single layer anastomosis and double layer anastomosis in terms of time taken to perform anastomosis, however there is no difference in postoperative anastomotic leak and duration of hospital stay.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20213652 ◽

2021 ◽

Author(s):

Manoranjan Kar ◽

Somu Singhal ◽

Bismoy Mondal ◽

Arijit Roy

Keyword(s):

Comparative Study ◽

Hospital Stay ◽

Intestinal Anastomosis ◽

Single Layer ◽

P Value ◽

Bowel Anastomosis ◽

Duration Of Hospital Stay ◽

Group A ◽

The Mean ◽

Group B

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.

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A Comparative Study of Single Layer Versus Double layer Intestinal Anastomosis

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i2.23403 ◽

2018 ◽

Vol 1 (2) ◽

pp. 98-101 ◽

Cited By ~ 1

Author(s):

Amar Gurung ◽

Santosh Shrestha ◽

Devendra Shrestha ◽

Suresh Raj Paudel ◽

David Shrestha ◽

...

Keyword(s):

Comparative Study ◽

Anastomotic Leak ◽

Double Layer ◽

Intestinal Anastomosis ◽

Single Layer ◽

Regional Hospital ◽

Layer Versus ◽

Layer Technique ◽

Postoperative Anastomotic Leak ◽

Western Regional

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.

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Absorbable suture material in carotid surgery

VASA ◽

10.1024/0301-1526/a000468 ◽

2015 ◽

Vol 44 (6) ◽

pp. 451-457 ◽

Cited By ~ 4

Author(s):

Vincenzo Gasbarro ◽

Luca Traina ◽

Francesco Mascoli ◽

Vincenzo Coscia ◽

Gianluca Buffone ◽

...

Keyword(s):

Suture Material ◽

Absorbable Suture ◽

Paediatric Surgery ◽

Carotid Surgery ◽

Suture Materials ◽

Absorbable Suture Material ◽

Absorbable Sutures ◽

Group A ◽

Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

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