Single Versus Double Layer Anastomotic Closure In Emergency Colonic Surgery: A Prospective Study.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 3
Abstract
Aims & Objective: General objective: To compare the safety and cost effectiveness of single layer and double layer anastomotic technique in emergency colonic surgery. Specific objective: To compare the duration of anastomosis and average length of stay in hospital. Secondary objective: To find out the morbidity pattern among both the study group. Material & Methods: “Single Versus Double Layer Anastomotic Closure In Emergency Colonic Surgery: A Prospective Study”. Was done on patient presenting Department of Surgery, VSSIMSAR, Burla, undergoing resection anastomosis of large bowel during emergency surgery from November, 2016 to September, 2018. A total of 134 (69 SL+65DL) cases aged 18-65 years of either sex who met the criteria and consented for the study were included in the study. Only emergency procedures with colo-colic & high intra peritoneal colo-rectal end to end type anastomoses were taken for the study. Both single and double layer anastomosis were done in interrupted manner by using non-absorbable atraumatic silk 2.0 .Single layer incorporate all the layers except the mucosa where as inner most layer of double layer is transmural and outer most is seromuscular Lembert sutures. Results: In this study majority of patient undergoing resection and anastomosis are volvulus of the colon 84.33%.Mean duration of intestinal anastomosis for SL is 20.87±2.07 min and for DL is 32.77±2.08 min.Mean duration of hospital stay for SL anastomosis is 8.85±3.88 days & for DL anastomosis is10.26±3.98 days.Median expenditure for SL and DL anastomosis is Rs 426 & 568 respectively.Double layer anastomosis had slightly higher leak rate 6 (9.23%) than single layer anastomosis 5 (7.25%) with total leak rate of11 (8.20%).Tension during anastomosis and faecal soiling significantly increased leak rate.Post-operative return of bowel sound for SL anastomosis is 2.67±0.97 days & for DL anastomosis is 3.52±0.94 days.Out of 11 patients of anastomotic leak 4 Undergone re-exploration and 7 managed conservatively. DL anastomosis had higher post-operative complication in compared to SL anastomosis though statistically insignificant but there is significant difference in terms of time taken for the anastomosis , duration of hospital stay and cost of suture material used between the two study groups. Conclusion: Single layered anastomosis more safer than DL technique in emergency colonic surgery.
Authors and Affiliations
Jitendra Kumar Sahoo
Keywords
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