Comparative Study between Use of Single Layer Interrupted Extra Mucosal Technique versus Double Layer Continuous Technique in Intestinal Anastomoses
Authors/Creators
- 1. Assistant Professor, Baroda Medical College, Gujarat, India
- 2. 3rd Year Resident, Baroda Medical College, Gujarat, India
- 3. General Surgeon, Chalmeda Anandrao Institute of Medical Sciences, Telangana, India
Description
Introduction: The anastomotic approach chosen is based on the location of the anastomosis, the quality and caliber of the bowel, and the underlying medical process. However, personal surgical experience and inclination continue to play a significant role in the decision to conduct a specific anastomosis. The two-layer technique’s sole noticeable drawback is that it takes considerable effort and time to complete. Recent papers have advocated for a monofilament plastic suture-based single-layer continuous anastomosis. This anastomosis can be created more quickly, for less money, and with a potentially lower risk of leaking than any other approach. Aims and Objectives: To compare single layer interrupted extra mucosal technique versus double layer continuous technique in intestinal anastomoses. Methods: This was prospective randomized control trial carried out on admitted patients and posted for resection and anastomosis surgery. Subjects was divided into two groups by alternative technique, namely, Group A. Patients, who received Single layered interrupted extra-mucosal anastomosis and Group B patients, who received double layered continuous intestinal anastomosis. In double layer anastomosis, anastomosis done using a 3-0 polygalactin continuous suturing for inner mucosal layer and a 3-0 silk interrupted for outer seromuscular layer. Each bite included 4 to 6mm of seromuscular wall. All single layer extramucosal interrupted anastomosis are constructed using a 3-0 Polygalactin round body needle suture beginning at the mesenteric border. Stitch advancement was approximately 5mm. Results: In Group A (single layer) the range of time taken for closure was between 7.67 minutes to18.00 minutes and mean duration was 14.35 minutes to perform an anastomosis, in Group B (double layer) the range was between 16.83 minutes to 24.83 minutes and mean duration was 21.43 minutes to perform a double layered anastomosis per operatively. The mean difference between two groups was 7.08 minutes, t value was 11.9 minutes and p<0.001, which is highly significant. Conclusion: The study has concluded that single layer intestinal anastomosis requires much lesser duration than double layer intestinal anastomoses technique.
Abstract (English)
Introduction: The anastomotic approach chosen is based on the location of the anastomosis, the quality and caliber of the bowel, and the underlying medical process. However, personal surgical experience and inclination continue to play a significant role in the decision to conduct a specific anastomosis. The two-layer technique’s sole noticeable drawback is that it takes considerable effort and time to complete. Recent papers have advocated for a monofilament plastic suture-based single-layer continuous anastomosis. This anastomosis can be created more quickly, for less money, and with a potentially lower risk of leaking than any other approach. Aims and Objectives: To compare single layer interrupted extra mucosal technique versus double layer continuous technique in intestinal anastomoses. Methods: This was prospective randomized control trial carried out on admitted patients and posted for resection and anastomosis surgery. Subjects was divided into two groups by alternative technique, namely, Group A. Patients, who received Single layered interrupted extra-mucosal anastomosis and Group B patients, who received double layered continuous intestinal anastomosis. In double layer anastomosis, anastomosis done using a 3-0 polygalactin continuous suturing for inner mucosal layer and a 3-0 silk interrupted for outer seromuscular layer. Each bite included 4 to 6mm of seromuscular wall. All single layer extramucosal interrupted anastomosis are constructed using a 3-0 Polygalactin round body needle suture beginning at the mesenteric border. Stitch advancement was approximately 5mm. Results: In Group A (single layer) the range of time taken for closure was between 7.67 minutes to18.00 minutes and mean duration was 14.35 minutes to perform an anastomosis, in Group B (double layer) the range was between 16.83 minutes to 24.83 minutes and mean duration was 21.43 minutes to perform a double layered anastomosis per operatively. The mean difference between two groups was 7.08 minutes, t value was 11.9 minutes and p<0.001, which is highly significant. Conclusion: The study has concluded that single layer intestinal anastomosis requires much lesser duration than double layer intestinal anastomoses technique.
Files
IJPCR,Vol15,Issue2,Article86.pdf
Files
(372.7 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:e83347c127aa44b84053aea2e05195e4
|
372.7 kB | Preview Download |
Additional details
Dates
- Accepted
-
2023-02-08
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue2,Article86.pdf
- Development Status
- Active
References
- 1. Hautefeuille P. Reflexions sur les sutures digetives: a propos de 570 sutures accomplies depuis 5 ans au surjet monoplan de monobrin. Chirurgie 1976; 102:153–165. 2. Harder F, Vogelbach P. Single-layer end-on continuous suture of colonic anastomoses. Am J Surg 1988; 155: 611–614. 3. Sarin S, Lightwood RG. Continuous single-layer gastrointestinal anastomosis: a prospective audit. Br J Surg 1989; 76:493–495. 4. Irwin ST, Krukowski ZH, Matheson NA. Single-layer anastomosis in the upper gastrointestinal tract. Br J Surg 1990; 77:643–644. 5. Max E, Sweeney B, Bailey HR, et al. Results of 1,000 single-layer continuous polypropylene intestinal anastomoses. Am J Surg 1991; 162: 461–467. 6. Ceraldi CM, Rypins EB, Monahan M, et al. Comparison of continuous singlelayer polypropylene anastomosis with double-layer and stapled anastomoses in elective colon resections. Am Surg 1993; 59:168–171. 7. Steele RJC. Continuous single-layer serosubmucosal anastomosis in the upper gastrointestinal tract. Br J Surg 1993; 80:1416–1417. 8. Thomson WHF, Robinson MHE. Onelayer continuously sutured colonic anastomosis. Br J Surg 1993; 80:1450– 1451. 9. AhChong AK, Chiu KM, Law IC, et al. Single-layer continuous anastom osis in gastrointestinal surgery: a prospective audit. Aust NZ J Surg 1996; 66:34–36.10. Brodsky JT, Dadian N. Single-layer continuous suture for gastrojejunostomy. Am Surg 1997; 63: 395–398. 11. Mr A. J. L. Brain; E. M. Kiely. Use of a single layer extramucosal suture for intestinal anastomosis in children., 1985;72(6):483–484. 12. Goulder Frances. Bowel anastomoses: The theory, the practice and the evidence base. World Journal of Gastrointestinal Surgery, 2012;4(9), 208. 13. Irvin TI, Goligher JC, Johnston D. A randomized prospective clinical trial of single layer and two layer inverting intestinal anastomosis. Br J Surg 1973; 60: 45740. 14. Everett WG. A comparison of one layer and two-layer techniques for colorectal anastomosis. Br J Surg 1975; 62: 13540. 15. Halstead WS. Circular suture of the intestine. Am J Med Sci 1887; 94: 436- 61. 16. Orr NWM. A single layer intestinal anastomosis. Br J Surg 1969; 56: 7714. 17. Gambee LP. Ten year's experience with a single layer anastomosis in colon surgery. Am J Surg 1956; 92: 222-7. 18. Wilkie PD. Cancer of the colon. Its surgical treatment. lancet 1934; i: 65-8. 19. Aird I. A Comparison to Surgical Studies. Edinburgh: Livingstone 1957; 891. 20. Browne D. Neo-natal intestinal obstruction. Proc R Soc Med 1951; 44: 6234. 21. Nixon HH. Intestinal obstruction in the new born. Arch Dis Child Getzen LC, Roe RD, Holloway CK. Comparative study of intestinal anastomotic healing in inverted and everted closures. Surg Gynecol Obstet 1966; 123: 1219-21. 22. Matheson NA, Valerio D, Farquharson A, Thomson H. Single layer anastomosis in tthe large bowel: 10 years experience. J R SOC Med 1981; 74: 44-8. 23. Khubchandani M, Upson J. Experience with single layer rectal anastomosis. J R Soc Med 1981; 74: 7368. 24. Benson CD, Lloyd JR, Smith JD. Resection and primary anastomosis in the management of stenosis and atresia of the jejunum and ileum. Paediatrics 1960; 26: 265-72. 25. Louw MB. Resection and end to end anastomosis in the management of atresia and stenosis of the small bowel. Surgery 1967; 62: 94C50. 26. Aniruthan D., Pranavi A. R., Sreenath G. S., & Kate V. Efficacy of single layered intestinal anastomosis over double layered intestinal anastomosisan open labelled, randomized controlled trial. International Journal of Surgery, 2020;78: 173-178. 27. Kumar A., & Kumar V. Single layer versus double layer intestinal anastomoses: a comparative study. International Surgery Journal, 2020; 7(9): 2991. 28. Mittelstädt A., von Loeffelholz T., Weber K., Denz A., Krautz C., Grützmann R., Weber G. F., & Brunner, M. Influence of interrupted versus continuous suture technique on intestinal anastomotic leakage rate in patients with Crohn's disease — a propensity score-matched analysis. International Journal of Colorectal Disease, 2022;37(10): 2245–2253. 29. Owaid L. S., Al-Shahwani I. W., Kamal Z. B., Hindosh L. N., Abdulrahman A. F., & Mihson H. S. Single layer extramucosal versus double layer intestinal anastomosis for colostomy closure: a prospective comparative study. AlKindy College Medical Journal, 2021;17(2): 95-99. 30. Yadav S., Gupta D. K., Patil P. H., Tiwari A., & Soni P. To Study the Pharmacotherapy of Diabetes Mellitus Type 2 Patient in Echo Health Care & Research Centre, Indore". Journal of Medical Research and Health Sciences, 2023;6(2): 2389–2397.