Intestinal anastomosis; comparative evaluation for safety, cost effectiveness, morbidity and complication of single versus double layer

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