Single-layer continuous versus two-layer interrupted intestinal anastomosis - A prospective randomized trial

Objective To determine the suitability of a single-layer continuous techniq ue for intestinal anastomosis in a surgical training program, Summary Background Data Several recent reports have advocated the use of a continuous single-layer technique for intestinal anastomosis. Purported adv antages include shorter time for construction, lower cost, and perhaps a lo wer rate of anastomotic leakage. The authors hypothesized that the single-l ayer continuous anastomosis could be safely introduced into a surgical trai ning program and that it could be performed in less time and at a lower cos t than the two-layer interrupted anastomosis. Methods The study was conducted during a 3-year period ending September 199 9. All adult patients requiring intestinal anastomosis were considered elig ible. Patients who required anastomosis to the stomach, duodenum, and rectu m were excluded. Patients were also excluded ii 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 conti nuous 3-0 polypropylene suture. Two-layer anastomoses were constructed usin g 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 stitc h was cut. Anastomotic leak was defined as radiographic demonstration of a fistula or nonabsorbable material draining from a wound after oral administ ration, or visible disruption of the suture line during reexploration, Results Sixty-five single-layer and 67 two-layer anastomoses were performed . The groups were evenly matched according to age, sex, diagnosis, and loca tion of the anastomosis. Two leaks (3.1%) occurred in the single-layer grou p and one (1.5%) in the two-layer group. Two abscesses (3.0%) occurred in e ach 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 pat ients; this difference did not quite reach statistical significance. Cost o f materials was $4.61 for the single-layer technique and $35.38 for the two -layer method. Conclusions A single-layer continuous anastomosis can be constructed in sig nificantly 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 incr ease in complications.