Single layer extramucosal versus double layer anastomosis for colostomy closure in children with anorectal malformation

Background: Intestinal anastomosis is one of the commonly performed procedure in gastrointestinal surgeries. The purpose of this study is to Assess safety, efficacy, cost effectiveness of single layer anastomosis over double layer anastomosis for colostomy closure in children with Anorectal Malformation at tertiary care centre. Materials and Methods: This prospective observational comparative study conducted between February 2016 to January 2021 consisting of 47 patients. All the children admitted for colostomy closure after definitive staged procedure for anorectal malformation were enrolled in the study. All anastomoses were of end-to-end type. The single layered anastomoses were performed by using interrupted 3-0 polydioxanone suture beginning at the mesenteric border and taking all layers of bowel wall except the mucosa into the bite. The double layered anastomoses were performed using interrupted 3-0 polydioxanone suture for the transmural inner layer and interrupted 3-0 polydioxanone Lembert sutures for outer seromuscular layer. Outcome parameters assessed were, quantity and cost of suture material used, time taken for anastomosis, time taken for surgery, postoperative return of peristalsis and passage of flatus, postoperative complications like paralytic ileus, bowel obstruction, anastomotic dehiscence diagnosed by presence of enteric contents like bile or faeces in drain or wound or diagnosed on radiological imaging like CT scans and hospital stay. Data were recorded in the case record form. Qualitative data was expressed in terms of proportions. Quantitative data was expressed in terms of Mean and Standard deviation. All the data collected was analysed by using SPSS 24.0 version IBM USA. Results: Out of total 47 children enrolled in study, 25 (53.19%)children were allocated to single layered extra mucosal intermittent anastomosis and 22 (46.81%) children to double layered anastomosis. All children admitted for colostomy closure had age ranges between 7 months to 36 months with mean age of 11.5 ±3.8 months.Amongst all the children undergoing anastomosis 35(74.47%) were males and 12(25.53%) were females. Observed outcome parameters like mean time taken for surgery in minutes (120.4±15.3 Vs 135.7±12.5), mean time taken for anastomosis in minutes (15.1±2.3 Vs 24.4±2.3), mean day of return of bowel sounds on postoperative day (2.40 Vs 3.74), mean day of first postoperative bowel movement (3.41 Vs 4.89 ) were significantly less in single layer anastomosis group than in double layer anastomosis. Suture material used in single layer anastomosis was lesser in quantity than used in double layer anastomosis. Post-operative complications were seen in 3 (06.38%) children of in single layer anastomosis group and 5 (10.63%) children of double layer anastomosis group. One child who underwent double layer anastomosis had anastomosis leak while none of child in single layer anastomosis group had leak. Mean duration of hospital stay was 5.95±1.40 days in single layer anastomosis group which is lesser than mean duration of hospital stay of 7.45 ± 1.95 days in double layer anastomosis group. Conclusion: Single layer intestinal anastomosis resulted in significant reduction in operative time, hastens the postoperative recovery of bowel function, reduces suture material, hospital stay and cost; without any difference in complications.