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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 1998 August;157(4):117-20

language: Italian

Manual single layer anastomoses in digestive tract surgery. First consecutive 75 cases

Maculotti L.

Azienda Ospedaliera, Ospedale Niguarda Ca’ Granda - Milano, Divisione di Chirurgia Generale «Andrea Ponti»


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Background. From May 1989 to April 1998 in a retrospective study 75 consecutive patients, operated on always and exclusively by the same surgeon, were evaluated in order to obtain technically homogeneous results on manual single layer anastomoses in digestive surgery.
Methods. All the patients received homogeneous perioperative treatment: no criteria for exclusion (i.e. occlusive syndrome, diabetes, obesity, immunodeficiency, dysproteinaemia, old age). The 94.7% of the patients was affected by malignancy; 46.6% was represented by men; mean age was 74.6 years. The anastomosis were manually performed with single layer polyglactin 910 suture, preferably extramucosal, continuous, with 3/0 vicryl: all layer in oesophageal and biliary anastomoses, interrupted sutures in low rectal anastomoses. The construction time averaged 30 min.
Results. After a 30-day follow-up from discharge, the incidence of anastomotic leakage and stenosis reached respectively the 5.3 and 2.6% and spontaneously resolved. Total post-operative mortality, not ascribebly to the technique, was the 4%. Oncological results and a comparison of other hand-sewn methods or the use of circular staplers were excluded.
Conclusions. After these experimental results the value is emphasized of manual single layer anastomoses in all digestive surgery, performed with precision and accurancy for low incidence complications, wide accomplishement opportunity, low cost and acceptable construction time.

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