Single layer versus double layer suture anastomosis of the gastrointestinal tract.

BACKGROUND: Gastrointestinal anastomosis (GIA) is an essential step to maintain the continuity of gastrointestinal tract following intestinal resection. GIA is still a source of significant controversy among surgeons due to the use of variety of approaches. Adequate apposition by single layer or double layer anastomosis may affect outcome after GIA OBJECTIVES: The objective of this review is to compare the effectiveness of single layer GIA (SGIA) versus double layer GIA (DGIA) being used in general surgery. The particular question we would attempt to answer will be; is single layer hand made GIA in surgical patients is as effective as double layer?

SEARCH METHODS: The CCCG (Colorectal Cancer Cochrane Group) Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2011), MEDLINE (until April 2011) , EMBASE ( The Intelligent Gateway to Biomedical & Pharmacological Information until April 2011), LILACS (The Latin American and Caribbean Health Sciences Library until April 2011 ) and Science Citation Index Expanded (SCI-E until April 2011) using the medical subject headings (MeSH) terms were searched without date, language or age restrictions.

SELECTION CRITERIA: Randomised, controlled trials comparing the effectiveness of SGIA versus DGIA DATA COLLECTION AND ANALYSIS: At least two review authors independently scrutinised search results, selected eligible studies and extracted data.

MAIN RESULTS: Seven randomised, controlled trials encompassing 842 patients undergoing SGIA versus DGIA were retrieved from the electronic databases. There were 408 patients in the SGIA group and 432 patients in the DGIA group. All included studies were small, with sample sizes ranging from 60 to 172. There was no heterogeneity among the included trials. Therefore, in the fixed effects model, incidence of anastomotic dehiscence, peri-operative complications and mortality was statistically equivalent between two techniques of GIA. Average hospital stay following SGIA and DGIA was also comparable. However, SGIA was superior in terms of shorter operative time. Sensitivity analysis of relatively good quality and poor quality trials supported same conclusion.

AUTHORS' CONCLUSIONS: SGIA can be performed quicker as compared to double layer GIA. SGIA is comparable to DGIA in terms of anastomotic leak, peri-operative complications, mortality and hospital stay. SGIA may routinely be used for GIA following bowel resection. However, since this conclusion is derived from smaller number of patients recruited in relatively moderate quality trials, further trials should be aimed to reduce the limitations of this review.