Single layered intestinal anastomosis: a safe and economic technique

The objective of the study was to compare single-layered intestinal anastomosis and double-layered intestinal anastomosis in terms of safety and cost-effectiveness. A comparative prospective study was conducted in the Department of General Surgery, SSG Hospital, Baroda, from May 2007 to November 2009. All the patients above the age of 12 years, requiring intestinal anastomosis in emergency or electively, were randomly assigned either of the group. Those requiring anastomosis to the stomach, or to the duodenum, or to the rectum were excluded. Single-layered anastomoses were constructed with a continuous 3-0 polypropylene suture. Double-layered anastomoses were constructed using interrupted 3-0 silk Lembert sutures for the outer layer and a continuous 3-0 polyglactin suture for the inner layer. Comparison was made in terms of time required for anastomosis, anastomotic leak and other complications, and the cost incurred. Seventy-three single-layered and 72 double-layered anastomoses were performed. Age and sex difference was not significant. The mean time required to construct single-layered anastomosis was 9.5 min and that for double-layered anastomosis was 19.3 min. Anastomotic leak and other complications were similar in both the groups. The length of hospital stay was also comparable. The expenditure for the procedure was significantly different (` 298 for single-layered anastomosis, whereas ` 390 for double-layered anastomosis). Single-layered intestinal anastomosis does not carry any increased risk of anastomotic leak when compared with the conventional double-layered technique, can be constructed in shorter time and at a lower cost.