Title : Comparative study of single layer extramucosal verses double layer intestinal anastomosis
Abstract:
Intestinal anastomosis is mostly performed procedure in both elective and emergency cases and therefore, it is necessary for surgeons and residents to be acquainted with the art of bowel anastomosis. This study is to determine the efficacy of single layer intestinal anastomosis in comparison with double layer intestinal anastomosis in terms of time duration required to perform anastomosis, postoperative complications like anastomotic leak, duration of hospital stay and cost effectiveness. This prospective comparative study carried out from July 2019 to June 2020 in the National Medical College and Teaching Hospital's Department of General Surgery. This study included 57 patients, and they were divided into two groups, group A (Double layer) and group B (Single layer) and cases were allotted to either groups after fulfilling inclusion and exclusion criteria. The mean age in group A was 40 ±16.657 years and in group B was 45±11.72 years. Strangulated Inguinal Hernia was diagnosed in 13 (22.80%) cases and ileoileal anastomosis was performed in 31 (54.39%) cases. Other cases were Ileal perforation due to trauma (8), Jejunal Stricture(7), Ileal Stricture(6), Status Post Ileostomy(6), Ileal perforation due to trauma(6), Jejunal perforation due to trauma(4), Status Post Colostomy(3), Gangrenous Ileum(1), Status Post Ileocolostomy(1), Caecal Perforation(1) and Ileocaecal Tuberculosis(1). In group A mean duration to perform anastomosis was 27.06 minutes and 18.78 minutes in Group B. The mean difference between two groups was 8.276 minutes, and p-value was <0.001. Overall complication in the form of anastomotic leak was noted in 8 patients (6%). In group A leak was observed in 6 cases whereas in Group B leak was observed in 2 cases; the p value was not significant. There was no statistical significance in hospital stay. Cost of single layer was less as compare with double layer. Our study revealed that Single layer extra mucosal intestinal anastomosis can be constructed in shorter period of time and is safe, cost effective with less post operative complications as compared to double layer anastomosis.
Keywords: Single Layer Anastomosis, Double Layer Anastomosis, Anastomotic Leak, Hospital Stay
