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Inflammatory Bowel Disease V: Surgical Management01:21

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Related Experiment Video

Updated: Mar 30, 2026

Reverse Needle Continuous Suture of the Pancreatic Duct to Jejunal Mucosal Pancreaticointestinal Anastomosis in Laparoscopic Pancreaticoduodenectomy
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Single-Layer Continuous Versus Double-Layer Continuous Suture in Colonic Anastomoses-a Randomized Multicentre Trial

F Herrle1, M K Diener2, S Freudenberg3

  • 1Surgical Department of the University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|November 4, 2015
PubMed
Summary

Single-layer continuous hand sutures (SLA) and double-layer suture anastomoses (DLA) showed similar safety for colonic surgery. Exploratory analysis suggests SLA may be equally effective, with shorter suture times, though the study lacked power.

Keywords:
Anastomosis techniqueAnastomotic leakageColonic anastomosisColorectal surgery

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Area of Science:

  • Colorectal surgery
  • Surgical techniques
  • Anastomotic integrity

Background:

  • Colonic anastomoses are crucial in colorectal surgery.
  • Established techniques include single-layer (SLA) and double-layer continuous hand sutures (DLA).
  • Comparative safety data between these hand suture techniques remain limited.

Purpose of the Study:

  • To compare the anastomotic safety of single-layer versus double-layer continuous hand sutures for colonic anastomoses.
  • To evaluate the incidence of postoperative complications, including anastomotic leakage.
  • To assess secondary outcomes such as suture duration and patient recovery.

Main Methods:

  • A multicentre randomized trial involving adult elective patients.
  • Comparison of single-layer suture anastomosis (SLA) versus double-layer suture anastomosis (DLA).
  • Primary endpoint: clinical anastomotic leakage at 3 months; secondary endpoints: suture duration, morbidity, stool patterns. Blinding of patients and assessors was employed.

Main Results:

  • The trial was stopped prematurely due to slow recruitment, with 252 patients analyzed (129 SLA, 123 DLA).
  • No significant difference in clinical anastomotic leakage was observed between SLA (3.1%) and DLA (4.9%) (p=0.532).
  • SLA demonstrated a significantly shorter suture duration (18 min vs. 24 min, p<0.001) with no significant differences in short-term outcomes.

Conclusions:

  • The study lacked sufficient power to definitively conclude on the superiority of either technique.
  • Exploratory findings suggest single-layer continuous hand suture may be a safe and efficient alternative to double-layer for elective colonic resections.
  • Further research is needed to confirm these exploratory results and establish definitive guidelines.