A comparison of one layer and two layer techniques for colorectal anastomosis. [Single or double layer? A controlled prospective study on the comparison of 2 suture technics in gastrointestinal anastomoses]. A controlled comparison one- and two-layer techniques of suture for high and low colorectal anastomoses. Double layer versus single layer intestinal anastomosis: a clinical trial. Intestinal anastomosis in children: a comparative study between two different techniques. A randomized prospective clinical trial of single-layer and two-layer inverting intestinal anastomoses. Single-layer continuous versus two-layer interrupted intestinal anastomosis: a prospective randomized trial.
In a randomized prospective clinical trial and layer and two layer techniques have been compared in 92 patients undergoing colorectal anastomosis. The results were assessed radiologically by barium studies on the tenth postoperative day. There was no significant difference in the incidence of anastomotic breakdown with either technique when the anastomosis was performed above the pelvic peritoneal reflection. When the anastomosis was situated below the pelvic peritoneum the incidence of dehiscence was significantly greater when a two layer technique was used. In a controlled clinical trial in 165 patients single layer anastomoses (n = 103) were compared to two layer anastomoses (n = 62). All anastomoses were controlled radiologically. The rate of dehiscence was 7.7% (n = 8) for the single layer group, 6.5% (n = 4) for the two layer group. Six patients died, 3 of both groups (2.9%:4.8%). There was no significant difference. However, for gastrectomies and anastomoses of small and large bowel single layer anastomoses seem to be preferable, for partial gastric resection two layer anastomoses. Factors predisposing for anastomotic breakdown are: age beyond 50, colo-rectal anastomoses, protein levels beyond 6 mg%, carcinosis peritonei. A controlled trial of one- and two-layer inverting techniques of sutures for the contruction of high and low colorectal anastomoses was conducted on 137 patients, the integrity of the suture lines being assessed clinically and by routine radiological examination after a small Gastrografin enema. A clinical diagnosis of anastomotic leakage was made in 9 patients (or perhaps more accurately in 5 only), but subclinical dehiscence was demonstrated radiologically in a further 39 patients (or perhaps 43). There was a slightly greater incidence of dehiscence after the one-layer technique of suture for both high and low anterior resection. One hundred and seventy two cases requiring bowel resection for various intestinal conditions were randomly selected for use of the double or single layer technique, for the end-to-end anastomosis. It was observed that the return of bowel function was quicker in the single layer group than in the double layer group, and the incidence of anastomotic leakage was lower in the former group. The aim of this study was to compare the incidence of surgical complications between two different surgical techniques for intestinal anastomosis in children.
                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.
                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.
                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. nan To determine the suitability of a single-layer continuous technique for intestinal anastomosis in a surgical training program.
                Several recent reports have advocated the use of a continuous single-layer technique for intestinal anastomosis. Purported advantages include shorter time for construction, lower cost, and perhaps a lower rate of anastomotic leakage. The authors hypothesized that the single-layer continuous anastomosis could be safely introduced into a surgical training program and that it could be performed in less time and at a lower cost than the two-layer interrupted anastomosis.
                The study was conducted during a 3-year period ending September 1999. All adult patients requiring intestinal anastomosis were considered eligible. Patients who required anastomosis to the stomach, duodenum, and rectum were excluded. Patients were also excluded if the surgeon did not believe either technique could be used. Patients were randomly assigned to one- or two-layer techniques. Single-layer anastomoses were performed with a continuous 3-0 polypropylene suture. Two-layer anastomoses were constructed using interrupted 3-0 silk Lembert sutures for the outer layer and a continuous 3-0 polyglycolic acid suture for the inner layer. The time for anastomosis began with the placement of the first stitch and ended when the last stitch was cut. Anastomotic leak was defined as radiographic demonstration of a fistula or nonabsorbable material draining from a wound after oral administration, or visible disruption of the suture line during reexploration.
                Sixty-five single-layer and 67 two-layer anastomoses were performed. The groups were evenly matched according to age, sex, diagnosis, and location of the anastomosis. Two leaks (3.1%) occurred in the single-layer group and one (1.5%) in the two-layer group. Two abscesses (3.0%) occurred in each group. A mean of 20.8 minutes was required to construct a single-layer anastomosis versus 30.7 minutes for the two-layer technique. Mean length of stay was 7.9 days for single-layer patients and 9.9 days for two-layer patients; this difference did not quite reach statistical significance. Cost of materials was $4.61 for the single-layer technique and $35.38 for the two-layer method.
                A single-layer continuous anastomosis can be constructed in significantly less time and with a similar rate of complications compared with the two-layer technique. It also costs less than any other method and can be incorporated into a surgical training program without a significant increase in complications.
SGIA can be performed quicker as compared to double layer GIA. SGIA is comparable to DGIA in terms of anastomotic leak, peri-operative complications, mortality and hospital stay. SGIA may routinely be used for GIA following bowel resection. However, since this conclusion is derived from smaller number of patients recruited in relatively moderate quality trials, further trials should be aimed to reduce the limitations of this review.