Gastro-Intestinal Anastomosis with Continuous Single-Layer Suture Versus Two Layers: A Prospective Randomized Study

Abstract

Ever since surgeons have been operating within the abdominal cavity, the wide variety of techniques for gastro-intestinal anastomosis have been the object of ongoing discussion. The ideal anastomotic technique must be atraumatic, waterproof, simple, easily learned and rapidly performed. Regardless of the method or suture material, the basis of anastomotic healing is an adequate blood supply, gentle handling of the tissues, tension-free approximation of cut ends of the bowel, good preoperative mechanical bowel preparation and antibiotic prophylaxis. As early as 1887 Halsted [1] reported good results in animal experiments with a single-layer intestinal anastomosis. Allen in 1979 [2] and Bailey in 1981 [3] and 1984 [4] reported satisfactory results with a continuous single-layer polypropylene colorectal anastomosis. These results, a preliminary experience with continuous single-layer anastomosis with a coated woven thread and the introduction of the atraumatic, resorbable, monofil 4/0 polydioxanon (PDS) suture (Ethicon, Edinburgh, UK) encouraged us to evaluate the continuous single-layer suture technique versus the previously routinely used double-layer suture technique in a prospective randomized study. Prior to the start of this study, the new technique was used in an initial learning phase of 3 months.