The incidence of fecal fistula after gastrointestinal anastomoses using either single-layer or double – layer anastomoses. A comparative study done in Samarra General Hospital

Abstract

Post-operative leak from GI anastomoses is common and serious condition that carry a high mortality and morbidity and to it is serous septic complication and fluid and  electrolyte disturbance . Also it cause severe fecal feeding problem with malnutrition and its complication, leading to sever complication.                             
.Aim of study: 
          Is to estimate the incidence of leak ( fecal fistula ) from the site of gastro-intestinal   anastomoses   using   different   technique   of   bowel anastomoses ( single layer vs. double layer bowel anastomoses).   Material & Methods : 
         100 patients [ 60♂ (60%)] & [ 40♀ (40%) ] are included in this study, which is conducted in SGH during the period between Jan. 2017- Dec. 2020 
.Informed Written consent was taken from all patients prior to enrolling into the study.  Only the patients who have small bowel and colonic anastomoses are taken in this study to estimate the incidence of leak after bowel anastomoses using either single layer or  double layer anastomoses 
.The patients are divided into 2 groups:-                             
 Group A : 50 patients with single layer anastomoses . 
Group B :  50 patients with double layer anastomoses. 
          Results : The overall incidence of fecal fistula in this study was 10% (10 patients from the 100 patients in this study ). Regarding patients with leak from the anastomoses, 7 patients (70%) had double layer & 3 patients (30%)had single layer anastomoses. The incidence of leak is more in female (60 % ) than in male (40 % )and more in large bowel anastomoses(70 % ) than small bowel anastomoses (30 %) . The overall morbidity is 30% from the post-op. leak .
          Conclusion: Bowel  leak from the  site of  bowel anastomoses is common and  carry high mortality and morbidity . Single layer meticulous  bowel anastomoses  carry lowest rate of leak and complication including narrowing of the bowel lumen prolongation of time of operative .