This study is a retrospective review of the medical records of a series of patients that underwent intestinal anastomosis on emergency or electively laparotomy in our institutions from 2010 to Aug. 2018. The study was approved by the chongqing children’s Institutional Review Board in using the medical records. The patients were considered eligible for entry into the study with primary intestinal anastomosis. All the patients should be aged between 1 year and 14 years. Exclusion criteria included patients requiring anastomosis involving the stomach, duodenum, or the rectum, and those with enteroplasty or proximal stom. Additionally, to minimize severity differences in the study population, patients managed in the intensive care unit (ICU) for more than 3 day were excluded. Of the 448 patients who met the inclusion criteria, the clinical and pathological details of all the cases were carefully recorded. Baseline data collected included age, gender, diagnosis, and Hb level prior to the operations. Treatment-related data included type of operation, operating time, estimated blood loss (EBL), transfusion rate and necessity for re-operation were also recorded. The surgical time was recorded from the first skin incision to the last suture placement for all the techniques.
Gastrointestinal anastomosis technique
The recruited patients were received anastomosis by two parallel, synchronous sewing methods: several groups using the interrupted sutureanastomosis in comparison to the continuous suture. All surgeries were performed under general anaesthesia by the consultant surgeons in our institute. The diseased bowel segment was removed using the standard technique, end-to-end or end to side construction were performed. The single-layered intestinal anastomoses were performed using a continuous 5–0 absorbable PDS suture (Ethicon Inc., Norderstedt, German) that began at the mesenteric border. The edge distance and needle pitch were approximately 3–5 mm of each bite, with all the layers incorporating. Only appropriate pressure could be subjected to the suture to avoid ischemia of the anastomosis while render the anastomosis water tight. The edges of the mesentery were conventionally closed. The double-layer interrupted suture was constructed using 5–0 silk suture for the inner transmural layer. The outer seromuscular were also taken in a interrupted manner.
Postoperative management and complications
All patients underwent the same postoperative programme, including fluid resuscitation, parenteral nutrition support, perioperative intravenous broad-spectrum antibiotics (average 4.32 days), including semisynthetic penicillins, cephalosporins, carbapenems, and metronidazole, enteral feeding, early ambulation and intensive care therapy (cardiorespiratory support or fluid resuscitation) if necessary. Total parenteral nutrition, intravenous fluids (5% dextrose/0.5% normal saline solution), H2 blockers and other electrolytes were prescribed as indicated clinically.
The primary outcome measure was the incidence of anastomotic leak, and the overall postoperative outcomes. Secondary outcomes included overal expenditure, and length of hospital stay, in days. We described the surgical and postoperative outcomes, including postoperative gastrointestinal function recovery, most common postoperative complications, and total lengths of hospital stay (the number of days from the day of operation until the date of discharge). The postoperative complications, including complication rates, complication types, such as wound infection, intra-abdominal or pelvic abscesses, anastomotic leaks, and the number of re-operation were also recorded. Early ileus was defined as more than 1 episode of nausea or vomiting within the hospital stay. The clinical leak was defined as the development of systemic sepsis associated with local peritoneal signs, the appearance of fecal material in the abdominal drains.
From January 2018 to December 2018, we have consecutively recorded the surgical time required for construction of the anastomosis in respective 10 patients of the two methods. The time recorded for construction of the anastomosis began with the placement of the first stitch and ended with cutting the excess material from the last stitch.
We first measured the demographic and preoperative clinical data and intraoperative factors to compare the two groups, then, the surgical and postoperative outcomes were subjected to statistical comparisons using SPSS 20.0 (IBM, Armonk, NY). Continuous data were presented as medians and interquartile ranges (IQR) or means±SDs as appropriate and analyzed with Student’s t-test or the Mann-Whitney U test, respectively. Categorical variables were reported as frequencies (percentages) and were analyzed by a chi-square test or Fisher’s exact test. The statistical significance was evaluated using a two-tailed 95 % confidence interval (CI), and statistical significance was established if p<0.05.