Single layer vs double layer intestinal anastomosis- a prospective comparative study.

Single layer vs double layer intestinal anastomosis- a prospective comparative study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Single layer vs double layer intestinal anastomosis- a prospective comparative study. Shahbaz Bashir, Ajaz Malik, Munir Wani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4943776/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Gastrointestinal anastomosis is one of the commonest surgical procedure performed worldwide. The aim of the anastomosis is to make a sound alignment of the bowel to restore functionally active gastrointestinal continuity. Whether to go for single layer or double layer anastomosis has long been debated. The purpose of our study was to compare single layer and double layer anastomosis in terms of anastomotic leak, length of hospital stay and duration required to perform anastomosis. Primary objectives were compare duration required to perform single and double layered intestinal anastomosiS and to compare the duration of hospital stay in single vs double layered bowel anastomosis and to study post operative complications in single and double layered intestinal anastomosis. Secondary objectives were to study relationship between pre operative Albumin & Hb levels and the risk of developing anastomotic leak. This was a prospective comparative study conducted in the Department of general and minimal invasive surgery. The study was conducted on patients presenting to SKIMS who underwent anastomosis of bowel from 2020 to 2022. Patients of either sex, in the age range 20–75 years with various conditions like ileostomy, colostomy, strangulated hernias, intestinal malignancies, Adhesion/Band obstruction of bowel etc, requiring intestinal anastomosis were included in the study. Children 75 years of age, patients with biliary & esophageal anastomosis were excluded. Baseline blood investigations were done in all patients. Single layer anastomosis was done in patients of Group A and double layer anastomosis was done in Group B patients. During surgery, the time duration required to perform single layer and double layer anastomosis was noted. In the post operative period all patients were observed for the development of anastomotic leak and all the patients were followed till discharge from the hospital. Anastomotic leak developed in three patients in Group A (6.8%) and Four patients in Group B (9.1%). The mean duration of hospital stay was 6.6 days and 7.21 days in Group A (single layer) and Group B (double layer) respectively. Mean duration to perform anastomosis in Group A (single layer) and Group B (double layer) was 17.68 and 27.22 minutes, respectively. The mean Hb of patients who developed leak was 9.35 and who did not develop leak was 10.73. The mean albumin level in patients who developed leak was 2.48 and in patients who did not develop leak was 3.12. Based on the results obtained in the present study following conclusions were drawn: 1. Duration required to perform a single layer anastomosis was significantly lesser when compared to double layer anastomosis. 2. There was no significant difference in anastomotic leak between the two groups. 3. There was no significant difference in duration of hospital stay between the two groups. 4. Low pre operative Albumin levels increase the risk of developing anastomotic leak. 5. There was no significant relationship between pre operative Hb level and the chance of developing anastomotic leak. Health sciences/Gastroenterology Health sciences/Oncology/Surgical oncology Intestinal anastomosis Single-layer Double-layer Operative time Anastomotic leak Figures Figure 1 Figure 2 Figure 3 1. Introduction Intestinal anastomosis is a critical surgical procedure involving the connection of two ends of the intestine. This study aims to compare the efficacy and safety of single-layer and double-layer anastomosis techniques. Specifically, we assess the operation time, postoperative complications, and duration of hospital stay for both methods. Additionally, the study examines the impact of preoperative nutritional status, particularly albumin levels, on anastomotic healing. 2. Methods 2.1 Study Design This prospective, comparative study was conducted over a period of one year at sher i kashmir institute of medical sciences (SKIMS) soura after approval by the institutional ethics committee (IEC SKIMS). A total of 88 patients undergoing intestinal anastomosis were included and randomly assigned to either the single-layer group (Group A) or the double-layer group (Group B), each comprising 44 patients. The study was conducted on patients presenting to SKIMS who underwent anastomosis of bowel from 2020 to 2022. Patients of either sex, in the age range 18–75 years with various conditions like ileostomy, colostomy, strangulated hernias, intestinal malignancies, Adhesion/Band obstruction of bowel etc, requiring intestinal anastomosis were included in the study. Children 75 years of age, patients with biliary & esophageal anastomosis were excluded. 2.2 Data Collection Data were collected on patient demographics, operation time, postoperative complications, duration of hospital stay, and preoperative albumin and hemoglobin levels. 2.3 Statistical Analysis Results are expressed as mean and standard deviation for continuous data and frequency as number and percentage. Unpaired t-test was used to compare mean levels between the two groups. Categorical data were analyzed using the Chi-square test. A p-value of 0.05 or less was considered statistically significant. 3. Results 3.1 Patient Demographics The study included 88 patients, equally divided between the single-layer (Group A) and double-layer (Group B) anastomosis groups ( Table 1 ). The age distribution was as follows: 28.4% were 20–40 years old, 50% were 40–60 years old, and 21.6% were over 60 years old ( Table 2 ). The mean age of participants was 49.43 years. There were 55 males (62.5%) and 33 females (37.5%) (Table 3 ). Group distribution: Both groups had equal number of patients, 44 each. Table 1 Table depicting the distribution of patients into two groups- single layer anastomosis group (group A) and double layer anastomosis group (group B) each having 44 patients. Group Distribution Frequency Percent A (Single Layer Group) 44 50.0 B (Double Layer Group) 44 50.0 Total 88 100.0 Age distribution: 25 patients in our study belonged to 20–40 years age group, 44 patients belonged to 40–60 years age group and 19 patients were above 60 years of age. Table 2 Table depicting the age distribution of patients with most patients (44) belonging to 40–60 years age group. Age Distribution Age No. Of patients Percentage 20–40 Years 25 28.4 40–60 Years 44 50 More than 60 Years 19 21.6 Total 88 100.0 Sex distribution: In our study 62.5% ( 55) patients were males and 37.5% (33) patients were females. Table 3 Table depicting the sex distribution of patients in our study. It shows the male preponderance in our study with 62.5% patients being males. Sex Distribution Sex No. Of patients Percentage Male 55 62.5 Female 33 37.5 Total 88 100.0 3.2 Type of Anastomosis Both groups had an equal distribution ( Table 4 ) of single-layer and double-layer anastomosis (50% each). Table 4 Table depicting the type of anastomosis done. It shows that single layer anastomosis was done in 44 (50%) patients and double layer anastomosis was done in 44 (50%) patients. Anastomosis Type Anastomosis No. Of patients Percentage Single Layer 44 50.0 Double Layer 44 50.0 Total 88 100.0 3.3 Operative Time The mean duration for single-layer anastomosis was 17.68 ± 1.88 minutes (range: 15–20 minutes), significantly less than the 27.22 ± 2.17 minutes (range: 20–30 minutes) required for double-layer anastomosis (p < 0.05) ( Table 5 ). This difference of 9.54 minutes was found to be highly significant (t = 22.02, p = 0). Table 5 Table comparing duration required to perform single and double layer anastomosis. Mean difference of duration between two groups is found as 9.54 and p-value is < 0.05 and is highly significant.Mean values of duration to perform single and double layered intestinal anastomosis are found as 17.68 and 27.22 minutes, respectively. Standard deviation values of duration to perform single and double layered intestinal anastomosis are found as 1.87 and 2.17 minutes respectively. Therefore, mean value of duration to perform single layered intestinal anastomosis was less than mean value of duration required to perform double layered intestinal anastomosis. Anastomosis. Duration required to perform single layered intestinal anastomosis (In Minutes) Duration required to perform double layered intestinal anastomosis (In Minutes) Single Layer Mean 17.6818 N 44 Std. Deviation 1.87732 Mean ± S.D 17.6818 ± 1.87732 Range 15–20 Double Layer Mean 27.22 N 44 Std. Deviation 2.17 Mean ± S.D 27.22 ± 2.17 Range 20–30 Mean Difference 9.54 t value (Unpaired t-test) 22.02 P-Value 0 3.4 Hospital Stay Duration The mean duration of hospital stay was 6.60 ± 1.99 days for single-layer and 7.21 ± 1.84 days for double-layer anastomosis( Table 6 ). While the single-layer group had a shorter mean stay, this difference was not statistically significant (p = 0.147). The range of hospital stay was 4–12 days for the single-layer group and 5–13 days for the double-layer group. Table 6 Table comparing the mean duration of hospital stay between the two groups. Anastomosis. Duration of hospital stay in Days for Single Layer Duration of hospital stay in Days for Double Layer Single Layer Mean 6.6047 N 43 Std. Deviation 1.98973 Double Layer Mean 7.214 N 42 Std. Deviation 1.8417 Total Mean 6.6047 7.214 N 43 42 Std. Deviation 1.98973 1.8417 Mean Difference 0.6096 t value (Unpaired t-test) 1.465 P-Value 0.147 Mean difference of duration between two groups is found as 0.6096 and p-value is 0.147 which is > 0.05 and is insignificant. Mean duration of hospital stay in days for single and double layer groups are found as 6.604 and 7.214 days respectively. Standard deviation values of hospital stay in single and double layered intestinal anastomosis groups is found as 1.98 and 1.84 days respectively. Therefore, mean value of hospital stay in days for single layered intestinal anastomosis was less than the mean value of hospital stay in days for double layered intestinal anastomosis. 3.5 Anastomotic Leak: Out of 88 patients, 7 developed anastomotic leaks (7.9%). In the single-layer group, there were 3 complications (6.8%) compared to 4 (9.1%) in the double-layer group as shown in Fig. 1 . This difference (p = 0.698) was not statistically significant ( Table 7 ). Of the 7 patients who developed leaks, 2 (29%) required re-exploration, while 5 (71%) were managed conservatively. Two patients, one from each group, required re-exploration and subsequently expired, resulting in an overall mortality rate of 2.27%. Both groups had equal mortality rates (2.27% each) as shown in Table 7 . 3.6 Outcome After Leak: Out of 88 patients, 7 developed anastomotic leaks (7.9%). Two patients expired, one from each group, resulting in an overall mortality of 2.27% (Table 7 ). Table 7 Table depicting the final outcome of patients who developed anastomotic leak. A total of 7 patients developed anastomotic leak (7.9%). A total of 2 patients, one each from single layer and double layer group, expired out of 88 patients ( overall mortality 2.27%). Both these patients were reexplored for anastomotic leak. One patient with anastomotic leak in the double layer group expired following reexploration (Group mortality of 2.27%) while the two other patients with anastomotic leak in single layer group were managed conservatively and were discharged after a prolonged hospital stay and had an unremarkable follow-up. One patient with anastomotic leak in double layer group expired after reexploration (Group mortality 2.27%). Three other patients with anastomotic leak in double layer group were managed conservatively. Group A n(%) Group B n(%) Total patients 44 44 Asymptomatic 41 (93.2%) 40 (90.9%) Leak 3 (6.8%) 4 (9.1%) Recovered 2 3 Re-explored 1 1 Death 1 (2.27%) 1 (2.27%) 3.7 Preoperative Albumin and Hemoglobin Levels: Relation between pre operative albumin and anastomotic leak (Fig. 2 ): Patients who developed leaks had notably lower mean albumin levels (2.48 g/dL) compared to those without leaks (3.12 g/dL) as depicted in Fig. 2 . This difference was statistically significant (p < 0.05), suggesting that preoperative albumin levels may be a predictor of anastomotic leak risk. Relation between pre operative hemoglobin level and anastomotic leak: While hemoglobin levels were lower in patients who developed leaks (9.35 g/dL vs. 10.73 g/dL in non-leak patients), this difference did not reach statistical significance (p > 0.05) as shown in Fig. 3 . However, the trend suggests that anemia might play a role in anastomotic healing, warranting further investigation in larger studies. 4. Discussion This study provides valuable insights into the comparative efficacy of single-layer and double-layer intestinal anastomosis techniques. The results demonstrate that single-layer anastomosis significantly reduces operation time compared to double-layer anastomosis without compromising patient safety or outcomes. 4.1 Operative Time The significant reduction in operative time for single-layer anastomosis aligns with previous studies. Burch et al. ( 2000 ) conducted a prospective randomized trial comparing single-layer continuous versus two-layer interrupted intestinal anastomosis in 65 patients, finding that the single-layer technique was faster and equally safe. Similarly, Sajid et al. ( 2009 ) performed a Cochrane review of 7 randomized controlled trials involving 842 patients, concluding that single-layer anastomosis was associated with shorter operative times without increased complications. 4.2 Postoperative Complications and Anastomotic Leaks Our study found no significant difference in postoperative complications or anastomotic leak rates between the two techniques. This is consistent with meta-analyses by Shikata et al. ( 2006 ) and Naraynsingh et al. ( 2011 ). Shikata et al. analyzed 6 randomized controlled trials with 670 participants, finding no significant differences in leak rates or mortality between single- and double-layer anastomoses. Naraynsingh et al. conducted a prospective study of 103 patients undergoing large bowel anastomosis, reporting comparable complication rates between the two techniques. 4.3 Hospital Stay Duration The lack of significant difference in hospital stay duration between the two groups suggests that the choice of anastomosis technique does not substantially impact overall recovery time. This finding is supported by similar results from Ordorica-Flores et al. ( 2018 ), who conducted a randomized controlled trial comparing single- and double-layer anastomosis in 64 pediatric patients, finding no significant difference in hospital stay. 4.4 Preoperative Albumin Levels and Anastomotic Healing A key finding of our study is the significant correlation between preoperative albumin levels and anastomotic leak risk. This underscores the importance of preoperative nutritional status in surgical outcomes, a concept well-established in the literature. Hennessey et al. ( 2010 ) conducted a multi-institutional study of 524 patients undergoing gastrointestinal surgery, identifying preoperative hypoalbuminemia as an independent risk factor for surgical site infections. Similarly, Truong et al. ( 2016 ) reviewed 23,348 patients undergoing colorectal surgery, finding that hypoalbuminemia was associated with increased morbidity and mortality. 4.5 Hemoglobin Levels and Leak Risk While we observed a trend towards lower hemoglobin levels in patients who developed leaks, this difference did not reach statistical significance. This finding contrasts with some studies that have suggested anemia as a risk factor for anastomotic leaks. Kwag et al. ( 2014 ) studied 153 patients undergoing colorectal cancer surgery and found that preoperative anemia was associated with increased postoperative morbidity. 4.6 Mortality and Severe Complications The overall mortality rate in our study was 2.27%, with one death in each group. This mortality rate is comparable to those reported in other studies of intestinal anastomosis. Choy et al. ( 2011 ) conducted a Cochrane review of 1,125 patients undergoing ileocolic anastomosis, reporting mortality rates ranging from 1.2–2.4%. Frasson et al. (2015) performed a multicentric study of 3,193 patients undergoing colon resection for cancer, reporting a 30-day mortality rate of 3.4%. 4.7 Limitations and Future Directions Our study has several limitations that should be addressed in future research. The sample size, while adequate for detecting differences in operative time, may have been insufficient to detect small differences in complication rates. A larger, multi-center trial could provide more definitive evidence. Additionally, long-term follow-up data on outcomes such as anastomotic strictures were not collected, which could be an important consideration for future studies. Furthermore, our study did not stratify results based on the specific anatomical location of the anastomosis (e.g., small bowel vs. large bowel). Given that different segments of the intestine have varying healing properties and leak risks (Matthiessen et al., 2004 ), future research should consider this factor in their analysis. Lastly, while our study focused on comparing single-layer and double-layer techniques, emerging technologies such as compression anastomosis devices and bioabsorbable staples are showing promise in early trials (Masoomi et al., 2013 ; Zbar et al., 2012 ). Future comparative studies including these novel techniques could help guide the evolution of intestinal anastomosis practices. 5. Conclusion Single-layer intestinal anastomosis is preferable due to its shorter procedural duration without compromising patient safety or outcomes. Ensuring optimal preoperative nutritional status, particularly albumin levels, is crucial for reducing the risk of anastomotic leaks. Further studies with larger sample sizes are recommended to validate these findings and refine surgical practices. Declarations Conflict of Interest: The authors declare that they have no conflict of interest. Ethical Approval: Approved by institutional ethical committee SKIMS soura Informed Consent: Informed consent was taken from all patients. Data availability statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Accordance: We confirm that all experiments in this study were performed in accordance with the relevant guidelines and regulations. Author Contribution A Shahbaz BashirB Ajaz A MalikC Munir A WaniA. wrote the whole manuscript A. B. Prepared the tables and graphsA. did the statistical analysis A.B.C. reviewed the manuscript. References Burch, J. M., Franciose, R. J., Moore, E. E., Biffl, W. L. & Offner, P. J. Single-layer continuous versus two-layer interrupted intestinal anastomosis: a prospective randomized trial. Ann. Surg. 231 (6), 832–837 (2000). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421070/ Sajid, M. S., Siddiqui, M. R. & Baig, M. K. Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database Syst. Reviews . (1), CD005477. 10.1002/14651858.CD005477.pub2/full (2009). https://www.cochranelibrary.com/cdsr/doi/ Shikata, S., Yamagishi, H., Taji, Y., Shimada, T. & Noguchi, Y. Single- versus two-layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg. 6 , 2. 10.1186/1471-2482-6-2 (2006). https://bmcsurg.biomedcentral.com/articles/ Naraynsingh, V., Maharaj, R., Dan, D. & Hariharan, S. Prospective study comparing single-layer and double-layer anastomosis in the large bowel. West Indian Med. J. 60 (1), 13–16 (2011). https://www.mona.uwi.edu/wimj/article/1197 Ordorica-Flores, R. M. et al. Intestinal anastomosis in children: a comparative study between two different techniques. Journal of Pediatric Surgery, 53(3), 513–516. (2018). https://www.jpedsurg.org/article/S0022-3468(17)30492-7/fulltext Hennessey, D. B. et al. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann. Surg. 252 (2), 325–329 (2010). https://journals.lww.com/annalsofsurgery/Abstract/2010/08000/Preoperative_Hypoalbuminemia_Is_an_Independent.19.aspx Truong, A., Hanna, M. H., Moghadamyeghaneh, Z. & Stamos, M. J. Implications of preoperative hypoalbuminemia in colorectal surgery. World J. Gastrointest. Surg. 8 (5), 353–362 (2016). https://www.wjgnet.com/1948-9366/full/v8/i5/353.htm Kwag, S. J., Kim, J. G., Kang, W. K., Lee, J. K. & Oh, S. T. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Annals Surg. Treat. Res. 86 (4), 206–211 (2014). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994622/ Choy, P. Y., Bissett, I. P., Docherty, J. G., Parry, B. R. & Merrie, A. E. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst. Reviews . (9), CD004320. 10.1002/14651858.CD004320.pub3/full (2011). https://www.cochranelibrary.com/cdsr/doi/ Frasson, M., Flor-Lorente, B., Rodríguez, J.L., Granero-Castro, P., Hervás, D., Alvarez Rico, M.A., … ANACO Study Group. (2015). Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective,national study with 3193 patients. Annals of Surgery, 262(2), 321–330. https://journals.lww.com/annalsofsurgery/Abstract/2015/08000/Risk_Factors_for_Anastomotic_Leak_After_Colon.22.aspx. Matthiessen, P., Hallböök, O., Andersson, M., Rutegård, J. & Sjödahl, R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 6 (6), 462–469. 10.1111/j.1463-1318.2004.00657.x (2004). https://onlinelibrary.wiley.com/doi/full/ Masoomi, H. et al. Compression anastomosis ring device in colorectal anastomosis: a review of 1,180 patients. The American Journal of Surgery, 205(4), 447–451. (2013). https://www.americanjournalofsurgery.com/article/S0002-9610(12)00648-X/fulltext Zbar, A. P., Nir, Y., Weizman, A., Rabau, M. & Senagore, A. Compression anastomoses in colorectal surgery: a review. Tech. Coloproctol. 16 (3), 187–199. 10.1007/s10151-012-0825-6 (2012). https://link.springer.com/article/ Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4943776","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":359668480,"identity":"1aa1763a-9f75-424a-8c11-41c659c7737e","order_by":0,"name":"Shahbaz Bashir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYBAC9gbmxgNAOoFBggdIVQAxM3MDXi08BxgbkLScAWlhJEULYxtIjJAW9saGAx/b6vL4Z/ce/PhzXm00fztQy4+Kbbi18BxsODiz7XCxxJ1zyRKS247nzjjM2MDYc+Y2Ti32EokNh3m3HUhsuJFjIGG47VhuA1ALM2Mbbi08EC11ifNv5Bj/SJxzLHc+kVqYEzfcyDGTONhQk7uBoBawX/4dTtx4Iy/NsuHYgdyNQC0H8fmFh7354IMPZ+oS593IPXzzR01d7rzzhw8++FGBWws6OAwmDxCtHgjqSFE8CkbBKBgFIwQAAKiCZ7kNxuSeAAAAAElFTkSuQmCC","orcid":"","institution":"Sher-i-Kashmir Institute of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Shahbaz","middleName":"","lastName":"Bashir","suffix":""},{"id":359668481,"identity":"3e06fdfd-ef1a-4e77-a21e-5e5162c529ec","order_by":1,"name":"Ajaz Malik","email":"","orcid":"","institution":"Sher-i-Kashmir Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ajaz","middleName":"","lastName":"Malik","suffix":""},{"id":359668482,"identity":"a7886f30-ca56-4029-859b-518001283dec","order_by":2,"name":"Munir Wani","email":"","orcid":"","institution":"Sher-i-Kashmir Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Munir","middleName":"","lastName":"Wani","suffix":""}],"badges":[],"createdAt":"2024-08-20 09:25:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4943776/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4943776/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66869469,"identity":"96a6239f-0f09-4247-9ffa-0dbb0f5f4e12","added_by":"auto","created_at":"2024-10-17 09:34:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":9289,"visible":true,"origin":"","legend":"\u003cp\u003eGraph depicting the number of patients who developed anastomotic leak in each group. Three patients from single layer group and four patients from double layer group developed anastomotic leak. The p value obtained is not significant (P-Value = 0.698).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4943776/v1/9b37ebba3e2b214e2e86897d.png"},{"id":66869467,"identity":"bd4e28a2-ddc3-4661-933a-54a2502cf6fc","added_by":"auto","created_at":"2024-10-17 09:34:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8053,"visible":true,"origin":"","legend":"\u003cp\u003eGraph depicting the relationship between mean albumin and anastomotic leak. The mean albumin level in patients who developed leak was 2.48 and in patients who did not develop leak was 3.12. The p value obtained is significant.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4943776/v1/1247e44ac55e5961d58f2d90.png"},{"id":66869468,"identity":"a5a555ef-c3fd-45ba-940d-77916e14a870","added_by":"auto","created_at":"2024-10-17 09:34:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":7898,"visible":true,"origin":"","legend":"\u003cp\u003eGraph depicting the relationship between mean hemoglobin and anastomotic leak.The mean Hb of patients who developed leak was 9.35 and who did not develop leak was 10.73. The p value obtained is not significant (P = 0.03).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4943776/v1/51737507386f99d5e8a7c987.png"},{"id":67110649,"identity":"dc40af7f-7012-4516-b60e-eeeeaa530605","added_by":"auto","created_at":"2024-10-21 09:39:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":582640,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4943776/v1/188ec72d-3130-4827-b85f-7fe87ad2c6aa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Single layer vs double layer intestinal anastomosis- a prospective comparative study.","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIntestinal anastomosis is a critical surgical procedure involving the connection of two ends of the intestine. This study aims to compare the efficacy and safety of single-layer and double-layer anastomosis techniques. Specifically, we assess the operation time, postoperative complications, and duration of hospital stay for both methods. Additionally, the study examines the impact of preoperative nutritional status, particularly albumin levels, on anastomotic healing.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003e This prospective, comparative study was conducted over a period of one year at sher i kashmir institute of medical sciences (SKIMS) soura after approval by the institutional ethics committee (IEC SKIMS). A total of 88 patients undergoing intestinal anastomosis were included and randomly assigned to either the single-layer group (Group A) or the double-layer group (Group B), each comprising 44 patients. The study was conducted on patients presenting to SKIMS who underwent anastomosis of bowel from 2020 to 2022. Patients of either sex, in the age range 18\u0026ndash;75 years with various conditions like ileostomy, colostomy, strangulated hernias, intestinal malignancies, Adhesion/Band obstruction of bowel etc, requiring intestinal anastomosis were included in the study. Children\u0026thinsp;\u0026lt;\u0026thinsp;20 years of age and elderly\u0026thinsp;\u0026gt;\u0026thinsp;75 years of age, patients with biliary \u0026amp; esophageal anastomosis were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data Collection\u003c/h2\u003e \u003cp\u003eData were collected on patient demographics, operation time, postoperative complications, duration of hospital stay, and preoperative albumin and hemoglobin levels.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical Analysis\u003c/h2\u003e \u003cp\u003eResults are expressed as mean and standard deviation for continuous data and frequency as number and percentage. Unpaired t-test was used to compare mean levels between the two groups. Categorical data were analyzed using the Chi-square test. A p-value of 0.05 or less was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Patient Demographics\u003c/h2\u003e \u003cp\u003eThe study included 88 patients, equally divided between the single-layer (Group A) and double-layer (Group B) anastomosis groups ( Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The age distribution was as follows: 28.4% were 20\u0026ndash;40 years old, 50% were 40\u0026ndash;60 years old, and 21.6% were over 60 years old ( Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean age of participants was 49.43 years. There were 55 males (62.5%) and 33 females (37.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGroup distribution:\u003c/p\u003e \u003cp\u003eBoth groups had equal number of patients, 44 each.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable depicting the distribution of patients into two groups- single layer anastomosis group (group A) and double layer anastomosis group (group B) each having 44 patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eGroup Distribution\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (Single Layer Group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (Double Layer Group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAge distribution:\u003c/p\u003e \u003cp\u003e25 patients in our study belonged to 20\u0026ndash;40 years age group, 44 patients belonged to 40\u0026ndash;60 years age group and 19 patients were above 60 years of age.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable depicting the age distribution of patients with most patients (44) belonging to 40\u0026ndash;60 years age group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge Distribution\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. Of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;40 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;60 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 60 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSex distribution:\u003c/p\u003e \u003cp\u003eIn our study 62.5% ( 55) patients were males and 37.5% (33) patients were females.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable depicting the sex distribution of patients in our study. It shows the male preponderance in our study with 62.5% patients being males.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSex Distribution\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. Of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Type of Anastomosis\u003c/h2\u003e \u003cp\u003eBoth groups had an equal distribution ( Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) of single-layer and double-layer anastomosis (50% each).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable depicting the type of anastomosis done. It shows that single layer anastomosis was done in 44 (50%) patients and double layer anastomosis was done in 44 (50%) patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAnastomosis Type\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. Of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle Layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble Layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Operative Time\u003c/h2\u003e \u003cp\u003eThe mean duration for single-layer anastomosis was 17.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 minutes (range: 15\u0026ndash;20 minutes), significantly less than the 27.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17 minutes (range: 20\u0026ndash;30 minutes) required for double-layer anastomosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) ( Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This difference of 9.54 minutes was found to be highly significant (t\u0026thinsp;=\u0026thinsp;22.02, p\u0026thinsp;=\u0026thinsp;0).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable comparing duration required to perform single and double layer anastomosis. Mean difference of duration between two groups is found as 9.54 and p-value is \u0026lt;\u0026thinsp;0.05 and is highly significant.Mean values of duration to perform single and double layered intestinal anastomosis are found as 17.68 and 27.22 minutes, respectively. Standard deviation values of duration to perform single and double layered intestinal anastomosis are found as 1.87 and 2.17 minutes respectively. Therefore, mean value of duration to perform single layered intestinal anastomosis was less than mean value of duration required to perform double layered intestinal anastomosis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnastomosis.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDuration required to perform single layered intestinal anastomosis (In Minutes)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDuration required to perform double layered intestinal anastomosis (In Minutes)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSingle Layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.6818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.87732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.6818\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eDouble Layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;S.D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e9.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value (Unpaired t-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e22.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Hospital Stay Duration\u003c/h2\u003e \u003cp\u003eThe mean duration of hospital stay was 6.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99 days for single-layer and 7.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84 days for double-layer anastomosis( Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). While the single-layer group had a shorter mean stay, this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.147). The range of hospital stay was 4\u0026ndash;12 days for the single-layer group and 5\u0026ndash;13 days for the double-layer group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable comparing the mean duration of hospital stay between the two groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnastomosis.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDuration of hospital stay in Days for Single Layer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDuration of hospital stay in Days for Double Layer\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSingle Layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.98973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDouble Layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.98973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.6096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et value (Unpaired t-test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMean difference of duration between two groups is found as 0.6096 and p-value is 0.147 which is \u0026gt;\u0026thinsp;0.05 and is insignificant. Mean duration of hospital stay in days for single and double layer groups are found as 6.604 and 7.214 days respectively. Standard deviation values of hospital stay in single and double layered intestinal anastomosis groups is found as 1.98 and 1.84 days respectively. Therefore, mean value of hospital stay in days for single layered intestinal anastomosis was less than the mean value of hospital stay in days for double layered intestinal anastomosis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Anastomotic Leak:\u003c/h2\u003e \u003cp\u003eOut of 88 patients, 7 developed anastomotic leaks (7.9%). In the single-layer group, there were 3 complications (6.8%) compared to 4 (9.1%) in the double-layer group as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. This difference (p\u0026thinsp;=\u0026thinsp;0.698) was not statistically significant ( Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf the 7 patients who developed leaks, 2 (29%) required re-exploration, while 5 (71%) were managed conservatively. Two patients, one from each group, required re-exploration and subsequently expired, resulting in an overall mortality rate of 2.27%. Both groups had equal mortality rates (2.27% each) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Outcome After Leak:\u003c/h2\u003e \u003cp\u003eOut of 88 patients, 7 developed anastomotic leaks (7.9%). Two patients expired, one from each group, resulting in an overall mortality of 2.27% (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable depicting the final outcome of patients who developed anastomotic leak. A total of 7 patients developed anastomotic leak (7.9%). A total of 2 patients, one each from single layer and double layer group, expired out of 88 patients ( overall mortality 2.27%). Both these patients were reexplored for anastomotic leak. One patient with anastomotic leak in the double layer group expired following reexploration (Group mortality of 2.27%) while the two other patients with anastomotic leak in single layer group were managed conservatively and were discharged after a prolonged hospital stay and had an unremarkable follow-up. One patient with anastomotic leak in double layer group expired after reexploration (Group mortality 2.27%). Three other patients with anastomotic leak in double layer group were managed conservatively.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsymptomatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (93.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (90.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecovered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-explored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.7 Preoperative Albumin and Hemoglobin Levels:\u003c/h2\u003e \u003cp\u003eRelation between pre operative albumin and anastomotic leak (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e):\u003c/p\u003e \u003cp\u003ePatients who developed leaks had notably lower mean albumin levels (2.48 g/dL) compared to those without leaks (3.12 g/dL) as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. This difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting that preoperative albumin levels may be a predictor of anastomotic leak risk.\u003c/p\u003e \u003cp\u003eRelation between pre operative hemoglobin level and anastomotic leak:\u003c/p\u003e \u003cp\u003eWhile hemoglobin levels were lower in patients who developed leaks (9.35 g/dL vs. 10.73 g/dL in non-leak patients), this difference did not reach statistical significance (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. However, the trend suggests that anemia might play a role in anastomotic healing, warranting further investigation in larger studies.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study provides valuable insights into the comparative efficacy of single-layer and double-layer intestinal anastomosis techniques. The results demonstrate that single-layer anastomosis significantly reduces operation time compared to double-layer anastomosis without compromising patient safety or outcomes.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Operative Time\u003c/h2\u003e \u003cp\u003eThe significant reduction in operative time for single-layer anastomosis aligns with previous studies. Burch et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) conducted a prospective randomized trial comparing single-layer continuous versus two-layer interrupted intestinal anastomosis in 65 patients, finding that the single-layer technique was faster and equally safe. Similarly, Sajid et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) performed a Cochrane review of 7 randomized controlled trials involving 842 patients, concluding that single-layer anastomosis was associated with shorter operative times without increased complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Postoperative Complications and Anastomotic Leaks\u003c/h2\u003e \u003cp\u003eOur study found no significant difference in postoperative complications or anastomotic leak rates between the two techniques. This is consistent with meta-analyses by Shikata et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) and Naraynsingh et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Shikata et al. analyzed 6 randomized controlled trials with 670 participants, finding no significant differences in leak rates or mortality between single- and double-layer anastomoses. Naraynsingh et al. conducted a prospective study of 103 patients undergoing large bowel anastomosis, reporting comparable complication rates between the two techniques.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Hospital Stay Duration\u003c/h2\u003e \u003cp\u003eThe lack of significant difference in hospital stay duration between the two groups suggests that the choice of anastomosis technique does not substantially impact overall recovery time. This finding is supported by similar results from Ordorica-Flores et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), who conducted a randomized controlled trial comparing single- and double-layer anastomosis in 64 pediatric patients, finding no significant difference in hospital stay.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Preoperative Albumin Levels and Anastomotic Healing\u003c/h2\u003e \u003cp\u003eA key finding of our study is the significant correlation between preoperative albumin levels and anastomotic leak risk. This underscores the importance of preoperative nutritional status in surgical outcomes, a concept well-established in the literature. Hennessey et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) conducted a multi-institutional study of 524 patients undergoing gastrointestinal surgery, identifying preoperative hypoalbuminemia as an independent risk factor for surgical site infections. Similarly, Truong et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) reviewed 23,348 patients undergoing colorectal surgery, finding that hypoalbuminemia was associated with increased morbidity and mortality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Hemoglobin Levels and Leak Risk\u003c/h2\u003e \u003cp\u003eWhile we observed a trend towards lower hemoglobin levels in patients who developed leaks, this difference did not reach statistical significance. This finding contrasts with some studies that have suggested anemia as a risk factor for anastomotic leaks. Kwag et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) studied 153 patients undergoing colorectal cancer surgery and found that preoperative anemia was associated with increased postoperative morbidity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Mortality and Severe Complications\u003c/h2\u003e \u003cp\u003eThe overall mortality rate in our study was 2.27%, with one death in each group. This mortality rate is comparable to those reported in other studies of intestinal anastomosis. Choy et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) conducted a Cochrane review of 1,125 patients undergoing ileocolic anastomosis, reporting mortality rates ranging from 1.2\u0026ndash;2.4%. Frasson et al. (2015) performed a multicentric study of 3,193 patients undergoing colon resection for cancer, reporting a 30-day mortality rate of 3.4%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Limitations and Future Directions\u003c/h2\u003e \u003cp\u003eOur study has several limitations that should be addressed in future research. The sample size, while adequate for detecting differences in operative time, may have been insufficient to detect small differences in complication rates. A larger, multi-center trial could provide more definitive evidence. Additionally, long-term follow-up data on outcomes such as anastomotic strictures were not collected, which could be an important consideration for future studies.\u003c/p\u003e \u003cp\u003eFurthermore, our study did not stratify results based on the specific anatomical location of the anastomosis (e.g., small bowel vs. large bowel). Given that different segments of the intestine have varying healing properties and leak risks (Matthiessen et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), future research should consider this factor in their analysis.\u003c/p\u003e \u003cp\u003eLastly, while our study focused on comparing single-layer and double-layer techniques, emerging technologies such as compression anastomosis devices and bioabsorbable staples are showing promise in early trials (Masoomi et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Zbar et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Future comparative studies including these novel techniques could help guide the evolution of intestinal anastomosis practices.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eSingle-layer intestinal anastomosis is preferable due to its shorter procedural duration without compromising patient safety or outcomes. Ensuring optimal preoperative nutritional status, particularly albumin levels, is crucial for reducing the risk of anastomotic leaks. Further studies with larger sample sizes are recommended to validate these findings and refine surgical practices.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConflict of Interest:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003eEthical Approval:\u003c/p\u003e\n\u003cp\u003eApproved by institutional ethical committee SKIMS soura\u003c/p\u003e\n\u003cp\u003eInformed Consent:\u003c/p\u003e\n\u003cp\u003eInformed consent was taken from all patients.\u003c/p\u003e\n\u003cp\u003eData availability statement:\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eAccordance:\u003c/p\u003e\n\u003cp\u003eWe confirm that all experiments in this study were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA Shahbaz BashirB Ajaz A MalikC Munir A WaniA. wrote the whole manuscript A. B. Prepared the tables and graphsA. did the statistical analysis A.B.C. reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBurch, J. M., Franciose, R. J., Moore, E. E., Biffl, W. L. \u0026amp; Offner, P. J. Single-layer continuous versus two-layer interrupted intestinal anastomosis: a prospective randomized trial. \u003cem\u003eAnn. Surg.\u003c/em\u003e \u003cb\u003e231\u003c/b\u003e (6), 832\u0026ndash;837 (2000). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421070/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421070/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSajid, M. S., Siddiqui, M. R. \u0026amp; Baig, M. K. 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Coloproctol.\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e (3), 187\u0026ndash;199. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10151-012-0825-6\u003c/span\u003e\u003cspan address=\"10.1007/s10151-012-0825-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2012). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intestinal anastomosis, Single-layer, Double-layer, Operative time, Anastomotic leak","lastPublishedDoi":"10.21203/rs.3.rs-4943776/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4943776/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGastrointestinal anastomosis is one of the commonest surgical procedure performed worldwide. The aim of the anastomosis is to make a sound alignment of the bowel to restore functionally active gastrointestinal continuity. Whether to go for single layer or double layer anastomosis has long been debated. The purpose of our study was to compare single layer and double layer anastomosis in terms of anastomotic leak, length of hospital stay and duration required to perform anastomosis. Primary objectives were compare duration required to perform single and double layered intestinal anastomosiS and to compare the duration of hospital stay in single vs double layered bowel anastomosis and to study post operative complications in single and double layered intestinal anastomosis. Secondary objectives were to study relationship between pre operative Albumin \u0026amp; Hb levels and the risk of developing anastomotic leak. This was a prospective comparative study conducted in the Department of general and minimal invasive surgery. The study was conducted on patients presenting to SKIMS who underwent anastomosis of bowel from 2020 to 2022. Patients of either sex, in the age range 20\u0026ndash;75 years with various conditions like ileostomy, colostomy, strangulated hernias, intestinal malignancies, Adhesion/Band obstruction of bowel etc, requiring intestinal anastomosis were included in the study. Children\u0026thinsp;\u0026lt;\u0026thinsp;20 years of age and elderly\u0026thinsp;\u0026gt;\u0026thinsp;75 years of age, patients with biliary \u0026amp; esophageal anastomosis were excluded. Baseline blood investigations were done in all patients. Single layer anastomosis was done in patients of Group A and double layer anastomosis was done in Group B patients. During surgery, the time duration required to perform single layer and double layer anastomosis was noted. In the post operative period all patients were observed for the development of anastomotic leak and all the patients were followed till discharge from the hospital. Anastomotic leak developed in three patients in Group A (6.8%) and Four patients in Group B (9.1%). The mean duration of hospital stay was 6.6 days and 7.21 days in Group A (single layer) and Group B (double layer) respectively. Mean duration to perform anastomosis in Group A (single layer) and Group B (double layer) was 17.68 and 27.22 minutes, respectively. The mean Hb of patients who developed leak was 9.35 and who did not develop leak was 10.73. The mean albumin level in patients who developed leak was 2.48 and in patients who did not develop leak was 3.12. Based on the results obtained in the present study following conclusions were drawn: 1. Duration required to perform a single layer anastomosis was significantly lesser when compared to double layer anastomosis. 2. There was no significant difference in anastomotic leak between the two groups. 3. There was no significant difference in duration of hospital stay between the two groups. 4. Low pre operative Albumin levels increase the risk of developing anastomotic leak. 5. There was no significant relationship between pre operative Hb level and the chance of developing anastomotic leak.\u003c/p\u003e","manuscriptTitle":"Single layer vs double layer intestinal anastomosis- a prospective comparative study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-17 09:33:55","doi":"10.21203/rs.3.rs-4943776/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce428270-24ab-4e98-86de-7c99128d9e82","owner":[],"postedDate":"October 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":38272690,"name":"Health sciences/Gastroenterology"},{"id":38272691,"name":"Health sciences/Oncology/Surgical oncology"}],"tags":[],"updatedAt":"2024-10-21T09:38:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-17 09:33:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4943776","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4943776","identity":"rs-4943776","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}