Gastroesophageal anastomosis: single-layer versus double-layer technique--an experience on 50 cases.

BACKGROUND: Considerable controversy exists regarding the optimum technique for gastroesophageal anastomosis. Double layer technique has long been considered important for safe healing but there is evidence that single layer technique is also safe and can be performed in much shorter time. The purpose of this study was to compare the outcome of single layer and double layer techniques for gastroesophageal anastomosis. METHOD: A prospective randomized study was conducted in cardiothoracic unit, Lady Reading Hospital from Jan 2006 to Jan 2008. Fifty patients with oesophageal carcinoma undergoing subtotal oesophagectomy were randomized to have the anastomosis by single layer continuous or double layer continuous technique (group A (n=24) and B (n=26) respectively). The demographic data, operative and anastomosis time, postoperative complications and hospital mortality were recorded on a proforma and analyzed on SPSS 10. RESULTS: There was no significant difference between group A and B in terms of age, gender, postoperative complications and duration of hospital stay. Anastomotic leak occurred in 4.2% patients in group A and 7.7% in group B (p=NS). Mean anastomosis time was 10.04 minutes in group A and 19.2 minutes in group B (p = 0.0001). Mean operative time was 163.83 minutes and 170.96 minutes in group A and B respectively. Overall hospital mortality was 2%; no deaths occurred due to anastomotic leak. CONCLUSION: Single layer continuous technique is equally safe and can be performed in shorter time and at a lower cost than the double layer technique.

Arteriovenous fistula construction in chronic haemodialysis patients: comparison of end-to-side and side-to-side techniques.

OBJECTIVE: To compare the techniques of end-to-side and side-to-side anastomosis in arteriovenous fistulae construction in terms of success rate and immediate postoperative complications. DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Ayub Hospital Complex, Abbottabad, from October 1999 to December 2002 and Khyber Teaching Hospital, Peshawar, from January 2003 to December 2003. PATIENTS AND METHODS: One hundred and ninety patients with end stage renal disease (ESRD) were included in the study. Arteriovenous fistula was constructed in these patients by two techniques i.e. end-to-side and side-to-side anastomosis. The two methods were compared in terms of duration of surgery, immediate success rate and short-term complications. RESULTS: Among 190 patients, 118 (62%) were males and 72 (38%) females. The age ranged between 24 to 66 years with average age of 54 years. Side-to-side anastomosis was done in 120 (63%) patients while end-to-side in 70 (37%) patients. The average duration of surgery in side-to-side group was 50 minutes and in end-to-side group it was 75 minutes. Bleeding occurred in 4(5.7%) cases in end-to-side group and 2(1.7%) patients in side-to-side group requiring re-exploration. The immediate failure rate of the procedure was 2.5% in side-to-side group and 7.5% in end-to-side group. Wound infection occurred in 1(1.4%) case in end-to-side group and 2(1.7%) cases in side-to-side group. CONCLUSION: In patients with end stage renal disease (ESRD) arteriovenous fistula construction by side-to-side anastomosis is less time-consuming and has less complications as compared to end-to-side technique.