RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
|1. |Name of the Candidate and Address |Dr. Yadhu K.L. |
| |(in block letters) |S/o Dr. K.V. LOKANATH |
| | |# 462, 7TH CROSS, 8TH MAIN, |
| | |P.J. EXTENSION, |
| | |DAVANGERE – 577 002. |
|2. |Name of the Institution |J.J.M. MEDICAL COLLEGE, |
| | |DAVANGERE-577004. |
|3. |Course of Study and Subject |POST GRADUATE |
| | |M.S. IN GENERAL SURGERY |
|4. |Date of admission to Course |01-06-2010 |
|5. |Title of the Topic |“Comparative study of Single LAYER VERSUS Double Layer Anastomosis of |
| | |small and large bowel” |
|6. |Brief resume of the intended work |
| |6.1 Need for the study: |
| |Asepsis, haemostasis, gentleness to tissue are the basis of surgeon’s art. Intestinal anastomosis has been excited interest in |
| |our day to day surgical practice since its beginning. The technique of resection and anastomosis since the inception has been |
| |experimentally evolved for better and efficient healing of anastomotic site. Intestinal anastomosis is very commonly performed |
| |technique in today’s surgical era. Number of techniques have been devised at different times yet there is no single technique |
| |which is internationally accepted.1 |
| |The creation of anastomosis for various clinical condition of small and large bowel is a major task in daily practice of surgery. |
| |Intestinal continuity can be restored by use of stapling devices, tissue glue, suture-less bio fragmentable ring, fibrin Glue |
| |(saint), laser welding devices, compression anastomotic clips, ring made up of nithinol, compression anastomotic ring locking |
| |procedure (CARP), hand sewn double layer suturing technique and single layer suturing technique by using different types of suture|
| |materials. |
| | In today’s cost conscious environment the use of staples for intestinal anastomosis does not suit common man as these staples |
| |are very expensive and should be used with caution and needs great surgical experience. But hand sewn anastomosis can be done in |
| |an appropriate time and can be performed at a lesser cost to suit the economy of common man. Hand sewn suturing technique remains |
| |the main stay for intestinal anastomosis in developing countries like India and is proven successful in most bowel surgery. |
| |This comparative study endeavors to compare outcome of single layer versus double layer intestinal anastomosis in small and large |
| |bowel in terms of duration required to perfom intestinal anastomosis, post operative complications like anastomotic leak and cost |
| |effectiveness.2,3,4 |
| |6.2 Review of Literature : |
| |The word anastomosis comes from a Greek word Anastomoo meaning to “furnish with a mouth”. Literally anastomosis is a surgical |
| |connection between the two structures. |
| |The first surgical anastomosis was performed by Jean Reybord in Lyon. |
| |According to descriptive study at Lady Reading Hospital, Peshawar in 2006, single layer serosubmucosal (extramucosal) technique is|
| |safe, easy to perform, simple to teach and with less anastomotic related morbidity and mortality.5 |
| |According to a comparative study at Saidu Group of Teaching Hospital, Swat in 2003, 1 out of 52 patients in single layer technique|
| |developed leakage and 8 out of 61 patients in double layer technique developed leakage.6 |
| |A meta anlaysis of randomized controlled trials at Kyoto prefectural university of medicine, Japan in 2006 clarified that |
| |considering duration of the anastomosis procedure and medical expenses, single layer intestinal anastomosis may prove the optimal |
| |choice in most surgical situations.4 |
| |According to prospective study at Dow University of Health Sciences & Civil Hospital, Karachi in 2009, single layer interrupted |
| |extra mucosal intestinal anastomosis can be constructed in less time with minimal complication compared with two-layered |
| |technique.1 |
| |According to a case controlled study at Ahwaz Educational Hospitals in 2006 Single layer anastomosis is safe; complications of |
| |single layer anastomosis are similar to double layer anastomosis; in addition operation time and total cost with the single layer |
| |technique were found to be decreased.2 |
| |A comparative study at Allied Hospital, Faisalabad revealed average time for the construction of the single layer anastomosis was |
| |20 minutes and in double layer was 35 minutes, leakage rate waste 12% in double layer and 6% in single layer. More over structure |
| |material consumption was more in two layer technique when comparative single layer technique.3 |
| |6.3 Objectives of the study: |
| |To compare duration required to perform single and double layered intestinal anastomosis. |
| |To study post operative complications like anastomotic leak in single and double layered intestinal anastomosis. |
| |To compare cost effective of suture material used in single and double layered intestinal anastomosis. |
|7. |Materials and methods: |
| |7.1 Source of data: |
| |Data will be collected from patients who come to Chigateri General Hospital and Bapuji Hospital, Davangere attached to J.J.M. |
| |Medical College, Davangere, who require intestinal resection and anastomosis for comparative study from June 2010 to May 2012(2 |
| |Years). |
| |7.2 Method of collection of data :( including sampling procedure if any) |
| |Sampling procedure: |
| |The patients selected for this study are those who are admitted with various clinical conditions requiring resection and anastomosis |
| |of small and large bowel. |
| |Based on detailed history, thorough clinical examinations, radiological examinations and USG abdomen, the diagnosis will be made. |
| |These patients will be subjected to the required pre operative investigations; after bowel preparation, ensuring fitness elective |
| |surgery will be done. |
| |Cases will be allotted to either groups alternatively requiring single layer anastomosis and double layer anastomosis for various |
| |clinical conditions as and when they get admitted. Intestinal anastomosis will be carried out in single layer continuous extramucosal|
| |technique with 2-0 vicryl and double layer continuous technique with 2-0 vicryl taking through all layers and seromucusular layer |
| |with 3-0 mersilk. |
| |Each case will be analyzed with respect to duration required to perform intestinal anastomosis, post operative complications like |
| |anastomotic leak and cost effectiveness of suture material. |
| |All cases will be followed up to discharge and subsequently for a follow up period of 2 weeks Each case will be analyzed with respect|
| |to duration required to perform intestinal anastomosis, postoperative complications like anastomotic leak and cost effectiveness of |
| |suture material. |
| |A minimum of 60 cases with the following inclusions and exclusion criteria will be selected for the study and will be allocated |
| |alternatively to each of the comparative study. |
| |Inclusion criteria : |
| |Age criteria 20-60 years. |
| |Elective surgical procedure for various clinical conditions requiring resection and anastomosis of small or large bowel. |
| |Anastomosis done by extramucosal single layer continuous technique or double layer continuous technique. |
| |Exclusion criteria : |
| |Patient not undergoing surgical treatment. |
| |Age less than 20 years and more than 60 years. |
| |Emergency resection and anastomosis of small and large bowel. |
| |Anastomosis carried out by interrupted by single or double layer technique |
| |A pretested proforma will be used to collect relevant information (patient data, clinical findings, lab investigations, follow up |
| |events etc.,) from all the selected patients. |
| |Statistical analysis : |
| |Comparison between the two groups will be done by Z test for proportions / Fisher’s exact test. |
| |7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please|
| |describe briefly: |
| |Yes |
| |Investigations: |
| |Routine: |
| |Hb % , TC, DC, ESR, |
| |Random blood sugar, blood urea, serum creatinine |
| |HIV, HbsAg, |
| |Urine Routine examination |
| |Plain X Ray Abdomen |
| |ECG |
| |USG Abdomen |
| |Special: |
| |Barium Meal follow through |
| |Barium Enema |
| |Colonoscopy |
| |Fistulogram |
| |7.4 Has ethical clearance been obtained from your institution in case of 7.3? |
| |Yes |
| | |
|8. |List Of References: |
| |Ayub M, Sheikh R, Gangat S, Rehman A. Single layer versus two layer intestinal anastomosis – a prospective study. Pakistan J Surg |
| |2009;25(3):141-143. |
| |Askarpour S, Sarmast MH, Peyvasteh M, Gholizadeh B. Comparision of single and double layer intestinal anastomosis is Ahwaz hospitals |
| |(2005-2006). Internet J Surg 2010;23(2). |
| |Khan RAA, Hameed F, Ahmed B, Dilawaiz M, Akram M. Intestinal anastomosis; comparative evaluation of safety, cost effectiveness, |
| |morbidity and complication of single versus double layer. Professional Med J 2010June;17(2);232-234. |
| |Shikata S, Yamagishi H, Taji Y, Shimada T, Noguchi Y. Single-versus two-layer intestinal anastomosis: a meta analysis of randomized |
| |controlled trials. BMC Surg 2006;6:2. |
| |Khan N, Rahman A, Sadiq M. Single layer interrupted serosubmucosal (Extral mucosal) intestinal anastomosis. J Med Scie |
| |2006Jan;14(1):10-13. |
| |Samiullah, Israr M, Zada N. Comparision of single layer interrupted intestinal anastomosis with double layer intestinal anastomosis. |
| |J Postgrad Med Inst 2003 Apr–Jun;17(2):263-6. |
| | | |
|9. |Signature of Candidate | |
| | |The technique of intestinal resection and anastomosis has evolved over the |
|10. |Remarks of Guide |past 200 years. Despite all the advances, hand sewn technique has stood the |
| | |test of time. Double layer, later single layer extramucosal anastomosis are |
| | |safe and cost effective. This study attempts to compare the two techniques. |
| | | |
|11. |Name and Designation of | |
| |(In Block Letters) | |
| |11.1 Guide |Dr. Deepak G. Udapudi M.S. |
| | |PROFESSOR, |
| | |Department of GENERAL Surgery, |
| | |J.J.M. Medical College, |
| | |Davangere – 577 004. |
| | | |
| |11.2 Signature | |
| | | |
| | | |
| |11.3 Co-Guide (If any) | |
| | |None |
| | | |
| |11.4 Signature | |
| | | |
| | | |
| |11.5 Head of Department |Dr. R.L. Chandrashekar M.S., |
| | |Professor and H.O.D., |
| | |Department of GENERAL Surgery, |
| | |J.J.M. Medical College, |
| | |Davangere – 577 004. |
| | | |
| | | |
| |11.6 Signature | |
| | | |
|12. |12.1 Remarks of the Chairman and Principal | |
| | | |
| | | |
| |12.2 Signature | |
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