The comparison of anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis

Author:

Warsinggih 1,Akil Fardah2,Lusikooy Ronald E.1,Ulfandi Devby1,Faruk Muhammad3,Hendarto Joko4,Jalil Muhammad R.3,Sinangka Andi A.M.3,Abdi Amirullah3

Affiliation:

1. Department of Surgery, Division of Digestive

2. Department of Internal Medicine, Division of Gastroenterohepatology

3. Department of Surgery

4. Department of Public Health Sciences, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia

Abstract

Background: Various intestine anastomosis techniques have been studied and used, but which is best is still debated. In our center, double-layer full-thickness intestine anastomosis was still considered as standard. However, a single-layer extramucosal intestine anastomosis has shown favorable results. This study created an anastomotic model to compare the anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis. Methods: This experimental study was performed in 20 randomized healthy male pigs, to be included either in Group A (Single-layer extramucosal intestine anastomosis) or Group B (Double-layer full-thickness intestine anastomosis). Enterotomy followed by an end-to-end anastomosis suture was performed in the jejunum. Fourteen days after the operation, any anastomosis leakage and its location was documented. The anastomosis strength was evaluated using manometry. Data were compared between groups using the Mann–Whitney U and Fischer Exact test, considering a significance level of P<0.05. Results: The overall mean intraluminal anastomotic bursting pressure was 4,257±1,185. Group A had a higher intraluminal anastomotic bursting pressure but was not statistically significant compared to group B (4.726±0.952 vs. 3.787±1.252 kilopascals, P=0.063). One leakage (5%, antimesenteric area) occurred in Group A and three leakages (15%, antimesenteric and mesenteric area) occurred in Group B. However, statistical analysis with Fischer exact showed no significant difference of leakage rate between those groups (P=0.291). Conclusions: The anastomosis strength and leakage did not differ significantly between the single-layer extramucosal intestine anastomosis group and the double-layer full-thickness anastomosis group. However, the location of leakage was most common in the antimesenteric area in the double-layer full-thickness anastomosis group.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine,Surgery

Reference9 articles.

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2. Comparison of strength of anastomosis between four different techniques for colorectal surgery;Tomori;Anticancer Res,2020

3. Systematic review of experimental studies on intestinal anastomosis;Yauw;Br J Surg,2015

4. The art of bowel anastomosis;Chen;Scand J Surg,2012

5. Prospective study of extramucosal single layer interrupted suture versus conventional two layer repair of intestinal anastomosis;Patil;Clin Surg,2020

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