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.

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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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Single Layer Extra-Mucosal Interrupted Anastomoses; Revalidated

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.2-1.59 ◽

2015 ◽

Vol 2 (1) ◽

pp. 22-26

Author(s):

Bilal Khattak ◽

Faiz -Ur- Rahman ◽

Irfan -Ul-Islam Nasir ◽

Muhammad Iftikhar ◽

Imtiaz Ahmad Khattak ◽

...

Keyword(s):

Comparative Study ◽

Double Layer ◽

Intestinal Anastomosis ◽

Single Layer ◽

P Value ◽

Burst Abdomen ◽

Group A ◽

Prospective Comparative Study ◽

Anastomosis Leakage ◽

Group B

Objective:To evaluate the safety regarding anastomotic failure of single layer interrupted extra mucosal intestinal anastomosis in comparison with double layer intestinal anastomosisMethodology:This prospective comparative study was conducted in surgical A unit of Lady reading Hospital Peshawar from 1st June 2007 to 1st February 2008 (8 months).Patients were divided into two groups, each comprising 60 patients. First 60 consecutive patients were included in Group A, for single layer extra mucosal anastomosis while Group B included last 60 consecutive patients for double layer inverting anastomosis (continuous inner and interrupted outer Lambert sutures). All the cases were admitted through OPD and emergency. The safety of two techniques of anastomosis was analyzed by comparing the outcome in terms of complications.Results:In this study, anastomosis leakage occurred only in 4 (3.33%) patients, one (1.67%) in group A and three (5%) in group B with a P-Value 0.138. Mean age of patient in group A was 36.15 years (+/- 6.0 years) and in group B was 33.25 years (+/- 5.5 years).Conclusion:Single layer extra-mucosal anastomosis has least anastomotic leakage and other complication like wound infection, septicemia, and collection and burst abdomen than in patients with double layer investing anastomosis.

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COMPARATIVE STUDY OF SINGLE LAYER CONTINUOUS VERSUS SINGLE LAYER INTERRUPTED EXTRA MUCOSAL TECHNIQUES IN SMALL INTESTINE ANASTOMOSIS

10.36106/ijsr/0332507 ◽

2021 ◽

pp. 40-41

Author(s):

Md Noman ◽

Shri Krishna Ranjan

Keyword(s):

Small Intestine ◽

Postoperative Complications ◽

Comparative Study ◽

Hospital Stay ◽

Intestinal Anastomosis ◽

Single Layer ◽

Anastomosis Group ◽

Group A ◽

Group B ◽

Demographic Features

Background: Intestinal anastomosis is most commonly performed surgical procedure both in emergency and elective settings therefore its leak and disruption is a common cause of post-operative morbidity and mortility. Gut anastomosis heals by the same mechanism as that of wound healing. The submucosa, is the strongest layer of gut wall therefore ideal anastomotic technique is the one which includes apposition and approximation of this layer. Aim:The outcome of comparative study of single layer continuous extra mucosal technique and single layer interrupted extra mucosal technique for the anastomosis of small bowel. Methods:This was a prospective study based on randomization and was carried out in surgery department of ANMMC&H, Gaya from 1 st March 2019 to 29th February 2020. Total Fifty patients were included in study requiring small intestine anastomosis and were divided in two groups based on randomization. Group Aincluded those patients in which the anastomosis performed by single layer continuous extra mucosal technique and Group B patients underwent single layer interrupted extramucosal technique for creation of anastomosis, Group Aincluded 24 patients (n=24) and Group B 26 patients (n=26) . The demographic features, time taken to create anastomosis , postoperative complications , number of deaths if any and hospital stay in days were recorded on a printed proforma and data analysis was done through computer soft ware SPSS 16. Results: Group Aand B were similar as for as the demographic features, postoperative complications and duration of hospital stay are concerned. 4.2% patients of Group A and 7.7% of Group B developed anastomotic dehiscence with non signicant p value. Mean time taken for creation of anastomosis was 10.04 minutes in continuous extra mucosal anastomosis group (Group A ) and 19.2 minutes in interrupted extra mucosal anastomosis [Group B ] (p=0.0001) Overall hospital mortality was 2%. Conclusion: Single layer continuous extra mucosal technique is as safe as interrupted extra mucosal anastomosis technique but can be performed in shorter time and can be a cost effective alternative for construction of bowel anastomosis.

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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 MIFEPRISTONE AND MISOPROSTOL VERSUS MISOPROSTOL ALONE IN INDUCTION OF LABOUR IN LATE INTRAUTERINE FETAL DEATH

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i2.1756 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Shivpal Moond ◽

K.P. Banerjee ◽

Rakhi Arya

Keyword(s):

Single Dose ◽

Comparative Study ◽

Fetal Death ◽

Induction Of Labour ◽

Labour Induction ◽

Intrauterine Fetal Death ◽

P Value ◽

Group A ◽

The Mean ◽

Group B

Objective: To compare efficacy, safety and tolerance of combination of Mifepristone and Misoprostol versus Misoprostol alone in induction of labour in late intrauterine fetal death (>24 weeks). Methods: This prospectively study included 160 women with late intrauterine fetal death (IUFD) after 24 weeks of gestation and divided the women randomly into two groups each containing 80 women. In Group-A : Mifepristone 200 mg single dose was given and after 24 hrs Tab Misoprostol (intravaginally) administered and repeated 4 hourly upto a maximum of 5 doses, while in Group-B : Only Tab Misoprostol administered intravaginally 4 hourly upto maximum 5 doses. Induction-delivery interval and number of doses of Misoprostol was calculated. Results: The mean induction-delivery interval in Group-A was 13.02 ± 3.74 hours and in Group-B was 16.09 ± 2.99 hours (p-value <0.0001). Mean doses of Misoprostol required in Group-A was 3.36 ± 1.08 hours and in Group-B was 4.32 ± 0.65 hours (p-value <0.0001). Conclusion: Combination of Mifepristone and Misoprostol is more effective as comparison to Misoprostol in terms of induction-delivery interval and number of doses of misoprostol required. Keywords: IUFD, mifepristone, misoprostol, induction of labour, induction-delivery interval.

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Is Nasogastric Tube essential in abdominal surgeries? Randomized controlled trail.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.10.4701 ◽

2021 ◽

Vol 28 (10) ◽

pp. 1397-1400

Author(s):

Muhammad Bilal ◽

Viqar Aslam ◽

Zaheeruddin ◽

Waqas Jan

Keyword(s):

Hospital Stay ◽

Nasogastric Tube ◽

P Value ◽

Randomized Controlled ◽

Group A ◽

Randomized Controlled Trail ◽

The Mean ◽

Group B ◽

Study Setting ◽

Tube Study

Objective: Objective was to compare mean hospital stay in patients with abdominal surgeries with and without Nasogastric tube. Study Design: Randomized Controlled Trail study. Setting: DHQ Charsadda. Period: Jan to Nov 2018. Material & Methods: One hundred and thirty two patients who underwent abdominal surgeries according to a preset inclusion criteria were in this study. These Patients were randomly assigned using sealed opaque envelopes containing computer‐generated random numbers into with and without NG tube. Mean hospital stay was noted in both groups. Student ‘t’ test was used to compare the mean hospital stay of both groups. Results: Mean age of patients in group A was 28.50 ± 9.28 years and for group B was 30.12+_9.09 years. Mean hospital stay for group A was 5.64+_2.32days and for group B was 8.73+_3.43 days with a p-value of < 0.000. Conclusion: Patient with nasogastric tube stay longer in hospital than without tube.

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The Impact of Preemptive Perianal Anaesthetic Block in Open Haemorrhoidectomy – a randomised controlled trial

10.53350/pjmhs211592165 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2165-2167

Author(s):

Wajeeha I. Andrabi ◽

M Asadullah Khawaja ◽

K. Fatima ◽

S I. Hussain Andrabi ◽

A. Shafique ◽

...

Keyword(s):

Placebo Group ◽

Hospital Stay ◽

Pain Intensity ◽

P Value ◽

Open Hemorrhoidectomy ◽

Group A ◽

The Mean ◽

Group B ◽

The Impact ◽

Mean Time

Background: the study was conducted to analyze the efficacy of 0.75% ropicaine at perianal block for open haemrrhoidectomy with regards to pain intensity, first demand of analgesia and hospital stay. Method: 50 patients were selected for open haemrrhoidectomy under GA which were divided into two groups.it was a randomized control trial in which sealed envelope method was used for the group delegation in which Group A was designated to the patients having the perianal block with 0.75% ropivacaine while the group B was the placebo group having normal saline injected in the perianal region. The variables compared were the first demand of analgesia, pain intensity and the duration of the hospital stay. In order to make the site of injection more authentic the injections were sited under ultrasound guidance. Results: The pain intensity which was analyzed with the visual analogue score (VAS) had a median of 3.8 (high=6, low=3) in group A while 5.5 (high=8, low=4) in the Group B with the p value of < 0.05. The mean time recorded for the first demand of analgesia was 6.20 ± 1.20 hours in the Group A which had improved from 1.20 ± 1.0 hours in the Placebo Group while the p value was < 0.001, while the mean time of hospital stay got reduced from 22.5±3.30 hours to 12.4 ± 3.10 hours with the significant p value of < 0.002. Conclusion: It was observed that with preemptive analgesia with 0.75% ropivacaine administered led to a substantial reduction in pain perception, request for an analgesic and hospital stay. Therefore it is appropriate to administer it before open hemorrhoidectomy. Keywords: preemptive anaesthesia, local anesthesia, postoperative pain, ropivacaine, open hemorrhoidectomy

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Outcome of Dynamic Compression Plate versus Interlock Intramedullary Nail for Management of Humeral Shaft Fractures

10.53350/pjmhs2115103387 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3387-3389

Author(s):

Mudassar Nazar ◽

Gauhar Nawaz Khan ◽

Hassan Raza Khosa ◽

Rizwan Anwar ◽

Muhammad Abdul Hanan ◽

...

Keyword(s):

Hospital Stay ◽

Intramedullary Nailing ◽

Dynamic Compression ◽

P Value ◽

Shoulder Impingement ◽

Shaft Fractures ◽

Group A ◽

The Mean ◽

Group B ◽

Humerus Shaft

Objective: To compare outcomes of interlock intramedullary nails with Dynamic compression plates for the treatment of humerus shaft fractures in terms of hospital stay time and shoulder Impingement. Subjects and Methods: In this comparative study, a total number of 74 patients having age 20-60 years who presented with closed and open Gustilo type I or II in middle third of humerus were included. Study was conducted in Islam hospital Sialkot and and Rajib Tayyip Erdogan Hospital, Muzaffargarh from June-2019 to June-2020. Group A (n=37) patients underwent dynamic compression plating (DCP) for treatment of fractures and group B (n=37) underwent interlocking intramedullary nailing (ILN) for humerus shaft fractures. We noted post-operative hospital stay, shoulder impingement and bone union rate in all patients. Results: The mean of patients included in this study was 42.45 (SD 9.89) years. There were 57 (77.03%) males and 17 (22.97%) females. The mean duration of fracture at the time of surgery was 39.98±7.23 days. Mean hospital stay was 4.72±1.23 days in in group A and 4.89±1.40 days in group B (p-value 0.60). There were 4 (10.8%) patients in group B in whom shoulder impingement occurred but there was no patient in group A with shoulder impingement (p-value 0.04). Complete union occurred in 35 (94.6%) patients in DCP group and in 34 (91.8%) patients in ILN group (p-value 0.64). Conclusion: Both DCP and ILN are associated with high bone union rates. The complications rate of ILN is higher in comparison to DCP group. Keywords: Humerus shaft fractures, dynamic compression plates, interlocking intramedullary nailing.

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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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Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

International Surgery Journal ◽

10.18203/2349-2902.isj20175410 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4058

Author(s):

Venkatarami Reddy Vutukuru ◽

Sivarama Krishna Gavini ◽

Chandramaliteeswaran C. ◽

Dinakar Reddy A. ◽

Varun Dasari ◽

...

Keyword(s):

Prospective Study ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

P Value ◽

Duration Of Hospital Stay ◽

Drain Fluid ◽

Group A ◽

Group B ◽

Better Than

Background: Postoperative pancreatic fistula (POPF) remains the most serious complication of Pancreaticoduodenectomy. ISGPF defined POPF in 2005 based on drain fluid amylase on or after day 3 and graded the severity. But as Grade A fistulas are not clinically relevant, most of the clinicians do not consider them as POPF. Hence exact incidence of POPF is not known. Our aim is to see weather drain fluid amylase on or after day 5 can define clinically relevant POPF better than day 3.Methods: Prospective study included all patients who underwent Pancreaticoduodenectomy during the period January 2013 to November 2016. Serum and Drain fluid amylase were analyzed on Day 3. Those who met criteria of POPF underwent repeat amylase on Day 5. These patients were divided into 2 groups. Group A includes patients whose Day 5 amylase normalized and Group B where elevated Amylase persisted. Outcomes were compared in 2 Groups in terms of clinically relevant POPF (CRF), DGE, Haemorrhage (PPH), hospital stay and 30 Days mortality. Results were analysed and p value <0.05 was considered significant.Results: On 110 patients, 44 (40%) met ISGPF criteria of POPF. Of 44, 36 (82%) had normalized Amylase on Day 5 (Group A). Only 8 (18%) had persistent elevated amylase (Group B). None in Group A had CRF, whereas in Group B, 6(75%) had CRF and 2(25%) had only biochemical leak (p<0.0001). DGE was significantly higher in Group B (87.5% vs. 33.3%; p=0.013). PPH was seen in only 1 patient (Group A). Duration of hospital stay and 30day mortality were similar.Conclusions: Drain fluid amylase levels on or after Day 5 defines clinically relevant POPF better than levels on or after day 3.

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