Introduction: Bowel resection and anastomosis are
very commonly performed gastrointestinal surgeries.
Anastomosis integrity is a major determinant of
mortality and morbidity among these patients,
however there is no clear consensus on the technique
used to create an anastomosis.

Aim: To compare and evaluate the clinical
outcomes with reference to the rate of anastomotic
leak, operating time and return of bowel activity
between single layer continuous versus double layer
interrupted intestinal anastomosis in risk-stratified
patients using APACHE-II scoring system.

Material and Methods: All the patients were risk
stratified using APACHE-II scoring system and those
with a score of more than ten were excluded. Computer
generated numbers were used for randomization.
On half of the patients, the intestinal anastomoses
were performed using a single layer continuous
technique and on the rest, using a double layer
interrupted technique. The criteria for anastomotic
leak are defined as complications of intra-abdominal
abscess, radiographic demonstration of a fistula,
visible disruption of suture line on re-exploration or
leak of enteric contents from the wound. Secondary
parameters including operating time, time of return of
bowel activity and hospital stay were also calculated.
Chi-square test was applied for categorical data (rate
of anastomotic leak) and student –t test was applied
for continuous data (time of anastomosis, return of
bowel activity and hospital stay).

Results: A total of 60 patients undergoing intestinal
anastomosis were included in the study. On 30
patients single layer (SL) anastomosis was performed
and an equal number of patients underwent double
layer (DL) anastomosis. The mean age for the SL
group was 33.17 years and 32.37 for the DL group.
The male to female ratio in the SL group and the
DL group were 23:7 and 26:4 respectively. The rate
of anastomotic leak in the SL group was 3.3% as
compared to 6.6% in the DL group but the difference
was statistically insignifcant as the p-value was
0.550. The mean operating time for the SL group was
15min 34 sec and it was signifcantly better than the
DL group with a mean of 24min 90 sec. The timing
of return of bowel sounds was also statistically
signifcant in the SL group (2.83 days) as compared to
the DL group (3.87 days). The difference in the mean
hospital stay was statistically insignifcant in both the
NIJS / Volume 11 Number 3 / July–September 2020
412 New Indian Journal of Surgery
groups (SL group was 7.20 days& DL group was 8.43
days).

Conclusion: We did not fnd any statistical
difference in the rate of anastomotic leak between the
two groups but a bigger sample size or meta-analysis
is required to establish superiority of one technique
over the other in terms of safety. Single layer was
signifcantly quicker to perform with an early return
of bowel activity.

Keywords: Intestinal anastomosis; Single layer;
Double layer; APACHE-II