Small Bowel Anastomosis Single-Layer Close Suturing—Open-Label Case Series

Abstract

In single-layer interrupted intestinal anastomosis, the inter-suture distance is conventionally kept at 4 to 5 mm. There is no human study which has described which is the appropriate inter-suture distance. A study that has investigated the gap between sutures in rats concluded that a small distance between sutures (1.5 mm) improves apposition compared with a larger distance (2.5 mm). We hypothesize that in humans also close inter-suture distance should have better apposition and healing. We performed case series to evaluate the rate of anastomotic leak and anastomotic stricture in ileoileal and ileocolic anastomosis with close inter-suture distance of 3 mm. The patients of ileostomy closure were taken for the study, and anastomosis was hand-sewn, single layer, full thickness, interrupted with 3-0 polydioxanone or polyglactin. We performed anastomosis in 38 patients. Five patients had superficial surgical site infection, which was managed with dressing and required secondary skin closure. No patients had an anastomotic leak. No patient had stricture related complaints in the mean follow-up period of 16 months (range 6 to 22 months). Our case series on anastomotic technique looks promising in decreasing anastomotic complications. A comparative study with randomization can throw more light on it.