Single-layer vs Double-layer Intestinal Anastomosis: A Prospective Comparative Study

The purpose of our study was to compare single-layer and double-layer anastomosis in terms of anastomotic leak, length of hospital stay, and duration required to perform anastomosis. The primary objectives were to compare the duration required to perform single- and double-layered intestinal anastomosis, to compare the duration of hospital stay in single- vs double-layered bowel anastomosis, and to study postoperative complications in single- and double-layered intestinal anastomosis. Secondary objectives were to study the relationship between preoperative albumin (Alb) and hemoglobin (Hb) levels and the risk of developing anastomotic leak.

This was a prospective comparative study conducted in the department of general and minimally invasive surgery. The study was conducted on patients presenting to Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Soura who underwent anastomosis of the bowel from 2020 to 2022. Patients of either sex, in the age range of 20-75 years with various conditions like ileostomy, colostomy, strangulated hernias, intestinal malignancies, and adhesion/band obstruction of the bowel etc., requiring intestinal anastomosis were included in the study. Children <20 years of age and elderly >75 years of age, patients with biliary and esophageal anastomosis were excluded. Baseline blood investigations were done in all patients. Single-layer anastomosis was done in patients of group A, and double-layer anastomosis was done in group B patients. During surgery, the time duration required to perform single-layer and double-layer anastomosis was noted. In the postoperative period, all patients were observed for the development of anastomotic leak, and all the patients were followed till discharge from the hospital.

Anastomotic leak developed in three patients in group A (6.8%) and four patients in group B (9.1%). The mean duration of hospital stay was 6.6 and 7.21 days in group A (single-layer) and group B (double-layer), respectively. The mean duration to perform anastomosis in group A (single-layer) and group B (double-layer) was 17.68 and 27.22 minutes, respectively. The mean Hb of patients who developed a leak was 9.35, and those who did not develop a leak was 10.73. The mean Alb level in patients who developed a leak was 2.48, and in patients who did not develop a leak was 3.12.

Based on the results obtained in the present study, the following conclusions were drawn: (1) The duration required to perform a single-layer anastomosis was significantly less when compared to double-layer anastomosis. (2) There was no significant difference in anastomotic leak between the two groups. (3) There was no significant difference in the duration of hospital stay between the two groups. (4) Low preoperative Alb levels increase the risk of developing anastomotic leak. (5) There was no significant relationship between preoperative Hb level and the chance of developing anastomotic leak.

Bashir S, Ahrar N, Khurshid MS, et al. Single-layer vs Double-layer Intestinal Anastomosis: A Prospective Comparative Study. Euroasian J Hepato-Gastroenterol 2025;15(1):18-23.