Single-Layer Versus Double-Layer Ileocolic Anastomosis in Right Hemicolectomy: A Randomized Controlled Trial
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Abstract
Background: Gastrointestinal surgery frequently necessitates bowel anastomosis, and the choice of technique significantly influences postoperative outcomes. Since Travers, Lembert, and Halsted established the early principles of intestinal suturing, anastomosis has emerged as a fundamental component of gastrointestinal surgery. To ensure anastomotic integrity and optimal patient recovery, meticulous surgical technique, precise tissue apposition, and gentle tissue handling are crucial. Both single-layer and double-layer anastomotic techniques are widely used, but there is ongoing debate about their comparative safety, efficiency, and effectiveness.
Objective: To evaluate and compare operative time, postoperative complications, hospital stay, and short-term mortality between single-layer and double-layer ileocolic anastomoses in patients undergoing right hemicolectomy.
Method: This is a single-center prospective hospital-based interventional double-blinded randomized controlled trial that included 46 patients undergoing right hemicolectomy at No. (1) Military Hospital (700 bedded) from 01/12/2022 to 31/05/2024 (total of 18 months). The patients were randomized into group A (single-layer anastomosis, n = 23) and group B (double-layer anastomosis, n = 23) using block randomization. Operative times, postoperative complications (anastomotic leak, surgical site infection), length of hospital stay, and 30-day mortality were recorded. Data was analyzed using Student’s t-test, with p<0.05 considered statistically significant.
Results: Among a total of 46 patients, 54.3% were male patients and 45.6% were female patients. Most patients in both groups were aged 41–60 years, while the fewest patients in Group A were over 80 years and in Group B were between 61 and 80 years. The mean operative time was significantly shorter in Group A (18.43 ± 2.68 minutes) compared to Group B (28.70 ± 2.55 minutes, p<0.001). Disease profiles included carcinoma, tuberculosis, and perforation. Both groups demonstrated high success rates with comparable complication profiles. Anastomotic leaks occurred in 4% of Group A and 9% of Group B (NS). Surgical site infection was seen in 9% of both groups. There was no 30-day mortality. The mean duration of the postoperative hospital stay was 7.39 ± 0.50 days in group A and 7.61 ± 0.50 days in group B (p = 0.14).
Conclusion: Both single-layer and double-layer anastomosis techniques are effective and safe for right hemicolectomy. The single-layer technique offers a significant reduction in operative time without increasing postoperative complications, suggesting it as a time-efficient alternative for bowel anastomosis.
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