Gastroesophageal anastomosis: single-layer versus double-layer technique--an experience on 50 cases

Considerable controversy exists regarding the optimum technique for gastroesophageal anastomosis. Double layer technique has long been considered important for safe healing but there is evidence that single layer technique is also safe and can be performed in much shorter time. The purpose of this study was to compare the outcome of single layer and double layer techniques for gastroesophageal anastomosis.

A prospective randomized study was conducted in cardiothoracic unit, Lady Reading Hospital from Jan 2006 to Jan 2008. Fifty patients with oesophageal carcinoma undergoing subtotal oesophagectomy were randomized to have the anastomosis by single layer continuous or double layer continuous technique (group A (n=24) and B (n=26) respectively). The demographic data, operative and anastomosis time, postoperative complications and hospital mortality were recorded on a proforma and analyzed on SPSS 10.

There was no significant difference between group A and B in terms of age, gender, postoperative complications and duration of hospital stay. Anastomotic leak occurred in 4.2% patients in group A and 7.7% in group B (p=NS). Mean anastomosis time was 10.04 minutes in group A and 19.2 minutes in group B (p = 0.0001). Mean operative time was 163.83 minutes and 170.96 minutes in group A and B respectively. Overall hospital mortality was 2%; no deaths occurred due to anastomotic leak.

Single layer continuous technique is equally safe and can be performed in shorter time and at a lower cost than the double layer technique.