Abstract

There are conflicting views on the use of single versus double layer technique of large bowel anastomosis. Historically, two-layer anastomosis has been the conventional method for most surgical situations. But it is tedious, time-consuming and there is still potential risk of anastomotic stricture formation. Single layer extra mucosal continuous intestinal anastomosis can be constructed in significantly shorter duration. No dogmatic evidence suggesting that double layered anastomosis is superior to single layered closure of bowel anastomosis. The role of demographic and clinical factors in aetiology of anastomotic leak is not yet completely understood.

The aim of this study was to investigate the associated factors and occurrence of anastomotic leak following single- and double-layer large bowel anastomosis at the University Teaching Hospitals, Adult Hospital in Lusaka, Zambia.

A cross-sectional study with an analytic component was conducted to identify factors and occurrence associated with anastomotic leak in single- or double-layer anastomosis technique. Convenience sampling was used to recruited sixty (60) participants. Thirty-three were allotted in single layer group while twenty-seven were allotted to a double layer group. They were matched for sex, age, past medical history and clinical diagnosis. Using SPSS version 22, both univariate and multivariate logistic regression were used to analyse data. The technique and Factors associated with anastomotic leak having a p-value of < 0.05 was considered significant.

Among patients who underwent single layer technique of anastomosis 40% had a leak compared to 60% in double layer technique, though the P value in both groups remained insignificant with regard to various factors. The crude and adjusted olds ratios on the logistic regression shows that the olds of anastomotic leak in either gender and corresponding age group increased by 7.91 and 7 folds with unit decrease in albumen and haemoglobin respectively. Males were four times more likely to leak than females. Haematocrit, diagnosis and age between 18 to 65 years had no influence on anastomosis leakage.

This study concluded that patients’ demographics and clinical characteristics play a great role in large bowel anastomosis irrespectively of the method of primary anastomosis. Preoperative assessment of these factors and appropriate intervention would improve outcome of large bowel anastomosis. The single layered extra-mucosal continuous or interrupted intestinal anastomosis is equally as safe and more cost effective than conventional double layered technique and deserved to be trained in our settings.

Keywords: One Layered Multi-Layered Bowel Anastomosis; Anastomotic Leak; Associated Factors

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