Analysis of Advantages of Single Layer Vs Double Layer Anastomosis of Bowel

Gokulnath Premchand, K S (2011) Analysis of Advantages of Single Layer Vs Double Layer Anastomosis of Bowel. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: In the modern day surgical practice, we come across situations in abdominal surgery, where we require resection and anastomosis of bowel. In small bowel resection and anastomosis, conventionally, two layer suturing technique i.e., inner layer with absorbable suture material in continuous fashion and outer layer with non absorbable suture material in a continuous or interrupted fashion, was considered secure. Recently, it has been advocated that anastomosis of small bowel with a single layer suturing using a non absorbable monofilament suture material in a continuous fashion has the same outcome when compared to double layer suturing technique. AIMS AND OBJECTIVES: 1. Complications of Single layer technique and the Double layer technique in emergency and elective surgeries. 2. Time consumption for performing single layer anastomosis as well as double layer anastomosis. 3. Cost effectiveness of single layer anastomosis. MATERIALS & METHODS: All adult patients requiring intestinal anastomosis at Govt. Rajaji Hospital from July 2008 to June 2010 were considered eligible. Totally 60 patients were included in our study. 30 patients under went single layer anastomosis and 30 patients underwent double layer anastomosis. Patients who underwent elective or emergency surgery were included in our study. Based on a careful history and meticulous physical examination, combined with adjunctive investigations, a decision to operate urgently or electively was taken. Baseline laboratory parameters like blood urea, blood sugar, serum creatinine, serum electrolytes, blood grouping and typing were done in all the cases, to rule out co morbid conditions. Evaluation of patients with Acute abdomen: Immediately after receiving the patient, primary survey was done, which included resuscitation secondary survey included definitive management. DISCUSSION: Our study assessed the efficacy and safety of single and double layer anastomosis after intestinal resection, in emergency and elective situations. Generally, conventional two layered technique is being practised. But this causes excessive mucosal inversion, causing narrowing of lumen and may lead to ischaemia of anastomotic site. To overcome this problem little mucosal and complete serosal continuous suturing technique was tried. It has the advantage of good opposition of serosal surfaces, no luminal narrowing and less damage to submucosal vascular plexus. In our study, anastomotic leakage in single layer group was 3.3% which is consistent with the other studies which showed leakage in the range of 1.3 to 7.7%. In emergency situations the anastomotic leak rate in single layer group is 5% The double layer group shows anastomotic leakage around 3.3% again which is consistent with the other studies. In emergency situations the anastomotic leak rate in double layer group 5%. CONCLUSION: Among the two methods of small intestinal bowel anastomosis which we have studied, our observations are ; 1. There is no much difference in the development of the complication in both the methods. However the development of complications in emergency situation is more marked in both the methods. 2. The time required to construct a single layer anastomosis is lesser than that of the double layer anastomosis. 3. Narrowing of the lumen of the bowel is lesser in single layer anastomosis when compared to double layer anastomosis. 4. Bowel movements recovered early in single layer anastomosis when compared to double layer anastomosis. 5. Finally, construction of single layer anastomosis of small bowel is cost effective when compared to that of double layer anastomosis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Single Layer, Double Layer Anastomosis, Bowel, Analysis, Advantages.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 18 Mar 2020 02:52
Last Modified: 18 Mar 2020 13:02

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