ABSTRACT
To evaluate the safety and cost effectiveness of single layer interrupted intestinal anastomosis in comparison with the double layer conventional method of intestinal anastomosis. Prospective comparative study. Surgical unit 4 DHQ hospital Faisalabad operated by single team during 12 months starting from Feb. 2007 to Jan. 2008. The cases were assigned to the two techniques, each being applied on alternate patient, single layer extra mucosal interrupted anastomosis and double layer anastomosis. In group 1 we used black silk 3/0 and in double layer we used vicryl 3/0 for inner continuous layer and black silk 3/0 for outer continuous layer. Comparison between two techniques was done on the bases of procedure time, cost effectiveness, morbidity in terms of rate of leakage. Average time for the construction of the single layer anastomosis was 20 minutes and in double layer was 35 minutes, the difference in average time is statistically significant [p<.001] while average duration of stay was 168 hrs and 216 hrs in group 1 and 2 respectively [p<.001]. Leakage rate was double [12%] in group 2 while 6% in group 1. Moreover structure material consumption was more in two layered technique and longer stay added to that lead to more hospital expenses on two layered technique. Anastomosis using a single layer interrupted extra mucosal technique was faster to perform, cost effective, less likely to leak and as strong as a 2-layer anastomosis
Subject(s)
Humans , Male , Female , Adult , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/economics , Intestines/surgery , Prospective Studies , Treatment OutcomeABSTRACT
Um estudo prospectivo foi realizado para analisar os resultados da anastomose por compressäo com o dispositivo AKA, em pacientes selecionados. Esta técnica foi aplicada em 24 pacientes, 15 com anastomoses colorretais altas, cinco com anastomoses colorretais baixas e quatro com anastomoses ileorretais. A maioria dos pacientes apresentou boa evoluçäo pós-operatória, com eliminaçäo inconsciente do anel anastomótico. Algumascomplicaçöes, no entanto, como deiscência, sangramento e estenose foram observadas. Os controles radiológicos e endocópicos se mostraram dentro da normalidade. Näo foi observada mortalidade relacionada com a técnica. Este dispositivo é de baixo custo financeiro, apresentando, no entanto, limitaçöes no seu emprego
Subject(s)
Humans , Male , Female , Anastomosis, Surgical/instrumentation , Intestines/surgery , Anastomosis, Surgical/economics , Anastomosis, Surgical/adverse effectsABSTRACT
Se presentan 18 enfermos en los que se pudo realizar la colectomía video-asistida en 13 (72 por ciento). En los 5 restantes (28 por ciento) hubo que convertir por punción de la arteria ilíaca, imposibilidad de ubicar la lesión, cánceres avanzados que invadían la vejiga y la pared abdominal y por metástasis hepática que requirió resección. La edad promedio fue de 65 años. Cinco se intervinieron por patología colónica benigna y 13 por cáncer de colon. Se exterioriza el colon por manilaparotomía y se ejecuta la anastomosis extra-abdominal o endo-abdominal con doble sutura mecánica. Hubo 2 complicaciones importantes: punción de la arteria ilíaca y lesión duodenal. La deambulación se produjo entre las 12 y 18 horas, el alta hospitalaria a los 4,7 días y los pacientes reasumieron sus actividades a los 8,6 días. No hubo mortalidad operatoria ni postoperatoria inherente al procedimiento. En los enfermos intervenidos por cáncer se encontraron entre 8 y 14 ganglios en las piezas de resección. Seguidos entre 7 y 39 meses ninguno de estos pacientes ha presentado recidivas abdominales ni parietales