Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials.
BACKGROUND
To compare single- with two- layer intestinal anastomosis after intestinal resection: a meta-analysis of randomized controlled trials.


METHODS
Randomized controlled trials comparing single- with two-layer intestinal anastomosis were identified using a systematic search of Medline, Embase and the Cochrane Library Databases covering articles published from 1966 to 2004. Outcome of primary interest was postoperative leak. A risk ratio for trial outcomes and weighted pooled estimates for data were calculated. A fixed-effect model weighted using Mantel-Haenszel methods and a random-effect model using DerSimonian-Laird methods were employed.


RESULTS
Six trials were analyzed, comprising 670 participants (single-layer group, n = 299; two-layer group, n = 371). Data on leaks were available from all included studies. Combined risk ratio using DerSimonian-Laird methods was 0.91 (95% CI = 0.49 to 1.69), and indicated no significant difference. Inter-study heterogeneity was significant (chi2 = 10.5, d.f. = 5, p = 0.06).


CONCLUSIONS
No evidence was found that two-layer intestinal anastomosis leads to fewer post-operative leaks than single layer. Considering duration of the anastomosis procedure and medical expenses, single-layer intestinal anastomosis appears to represent the optimal choice for most surgical situations.
Shikata
Satoru
S
Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. shikata@kuhp.kyoto-u.ac.jp
Yamagishi
Hisakazu
H
Taji
Yoshinori
Y
Shimada
Toshihiko
T
Noguchi
Yoshinori
Y
D000714:Anastomosis, Surgical / Q000379:methods*; D006801:Humans; D007422:Intestines / Q000601:surgery*; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D013536:Suture Techniques