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Intestinal anastomosis in children: a comparative study between two different techniques
R M Ordorica-Flores1, E Bracho-Blanchet, J Nieto-Zermeño
1Department of Pediatric Surgery, Hospital Infantil de Mexico Federico Gómez, Universidad Nacional Autónoma de México, México City.
Insights
One-layer intestinal anastomosis in children is as safe as two-layer techniques but significantly faster. This single-layer method is recommended for pediatric intestinal surgery due to its efficiency and comparable safety outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Gastrointestinal Surgery
Background:
- Intestinal anastomosis is a critical procedure in pediatric surgery.
- Choosing the optimal technique impacts patient outcomes and surgical efficiency.
- Comparing single-layer versus two-layer suture methods is essential for pediatric cases.
Purpose of the Study:
- To compare the incidence of surgical complications between one-layer and two-layer intestinal anastomosis techniques in children.
- To evaluate the safety and efficacy of different suture methods for pediatric intestinal repair.
Main Methods:
- A randomized clinical trial involving 86 children undergoing intestinal anastomosis.
- Comparison of single-layer (Gambee stitches) versus two-layer (Connel-Mayo/Lembert stitches) techniques.
- Blind follow-up for 18–36 months to assess postoperative recovery and complications.
Main Results:
- No significant difference in intestinal dehiscence rates between the two groups (5.8% overall).
- Single-layer anastomosis took significantly less surgical time (26 minutes) compared to two-layer (43 minutes) (P<.001).
- No instances of stenosis were observed during the follow-up period.
Conclusions:
- One-layer intestinal anastomosis is as safe as two-layer techniques in pediatric patients.
- The single-layer method offers a significant reduction in operative time.
- Single-layer suture technique is proposed as the preferred method for pediatric intestinal anastomosis.
Purpose:
The aim of this study was to compare the incidence of surgical complications between two different surgical techniques for intestinal anastomosis in children.
Methods:
This was a clinically controlled, randomized study with blind follow-up from 18 to 36 months performed at the Reference Government Hospital in Mexico City. Eighty-six children required intestinal anastomosis, ages ranged between 1 month and 16 years, with emergency or elective surgery. Anastomoses of duodenum, rectum, with enteroplasty or protected with a proximal stoma were excluded. Two randomized groups were formed: (1) anastomosis with one layer of suture (Gambee stitches) and (2) with two layers of suture (first with Connel-Mayo stitches then with Lembert). Both groups were controlled in the principal variables without differences, and the follow-up concerning postoperative recovery was blind for the surgical team.
Results:
Forty-two cases in group 1 and 44 in group 2 were compared. Intestinal dehiscence was found in 5 of 86 (5.8%), two from group I and three from group II (P value, not significant). Surgical time for anastomosis with one layer was an average of 26 minutes versus 43 minutes with two layers (P<.001). There were no stenoses within the follow-up period.
Conclusions:
This study proves that intestinal anastomosis with one layer of suture is as safe as anastomosis with two layers in children, and the time spent for completion of the procedure is significantly less with one plane of suture. For those reasons, it is the method of choice for intestinal anastomosis in children.
