Single layer vs double layer intestinal anastomosis- a prospective comparative study.

Abstract Gastrointestinal anastomosis is one of the commonest surgical procedure performed worldwide. The aim of the anastomosis is to make a sound alignment of the bowel to restore functionally active gastrointestinal continuity. Whether to go for single layer or double layer anastomosis has long been debated. 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. Primary objectives were compare duration required to perform single and double layered intestinal anastomosiS and to compare the duration of hospital stay in single vs double layered bowel anastomosis and to study post operative complications in single and double layered intestinal anastomosis. Secondary objectives were to study relationship between pre operative Albumin & Hb levels and the risk of developing anastomotic leak. This was a prospective comparative study conducted in the Department of general and minimal invasive surgery. The study was conducted on patients presenting to SKIMS who underwent anastomosis of bowel from 2020 to 2022. Patients of either sex, in the age range 20–75 years with various conditions like ileostomy, colostomy, strangulated hernias, intestinal malignancies, Adhesion/Band obstruction of bowel etc, requiring intestinal anastomosis were included in the study. Children < 20 years of age and elderly > 75 years of age, patients with biliary & 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 post operative 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 days and 7.21 days in Group A (single layer) and Group B (double layer) respectively. 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 leak was 9.35 and who did not develop leak was 10.73. The mean albumin level in patients who developed leak was 2.48 and in patients who did not develop leak was 3.12. Based on the results obtained in the present study following conclusions were drawn: 1. Duration required to perform a single layer anastomosis was significantly lesser 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 duration of hospital stay between the two groups. 4. Low pre operative Albumin levels increase the risk of developing anastomotic leak. 5. There was no significant relationship between pre operative Hb level and the chance of developing anastomotic leak.