Shweta Sharma1 , Sudhansu Shekhar Mohanty2 , Sushanta Kumar Das3
BACKGROUND Anastomosis is a surgical procedure where in two hollow viscera are approximated together to establish the continuity. We wanted to compare the single layer and double layer gastrointestinal anastomosis in terms of their technical ease, duration of procedure, cost effectiveness, duration of hospital stay, anastomotic leak and other post-operative complications. METHODS This prospective study was conducted in the Postgraduate Department of General Surgery, M.K.C.G. Medical College and Hospital, Berhampur during the period July 2017 to June 2019. A total of 110 patients requiring small bowel and large bowel anastomosis both in elective and emergency cases were included in the study. Single layer anastomosis (SL) was done in 50 cases and double layer anastomosis (DL) in 60 cases. SL was done with extra mucosal interrupted suture with polyglactin curved round body 2-0 or Silk 2-0 curved round body or Prolene® 2-0 curved round body. In DL, first layer was continuous through and through with polyglactin round body 2-0 followed by outer Lembert suture with silk round body 2-0 or Polypropylene 2-0. The stitches were placed at an interval of 4-6 mm and mucosal eversion was strictly avoided. Drainage of anastomotic site is provided in all cases. RESULTS Mean time taken for single layer was 21.62 minutes and double layer was 31.22 minutes (p value 0.000), Mean Duration of hospital stay in SL was 5.74 days and DL was 7.70 days (p value 0.000). Mean expenditure in SL was 1140 rupees, DL was 1950 rupees (p value 0.000). Leakage rates in SL was 2% (1/50) and DL was 11.7% (7/60) (p value 0.06). CONCLUSIONS SL anastomosis is more cost effective, has shorter operating time, shows better patient compliance in terms of hospital stay with comparable leakage rates with DL, and is therefore the procedure of choice in routine surgical practice.
