Six years old child with Obstructed hernia on Exploration bowel was found gangrenous- True about anastomosis
Ans. (d) Single layer taking submucosa(Ref Bailey and Love 27th edition page 97)In obstructed hernias, Gangrenous bowel will be resected and anastomosis of normal bowel will be done by one of the following methods:Kocher's method:* Two layered technique* First layer made up of continuous all layer suture made up of catgut.* Second layer made up of inverting continuous or interrupted seromuscular suture by Silk.Halsted method:* One layered extramucosal closure using absorbable sutures.* This must always include submucosa, the strongest layer with high collagen content.* This can be interrupted or continuous suture using synthetic absorbable polymers like Polyglactic acid Vicryl.Salient points from Bailey:* The Gold standard during bowel anastomosis is arterial bleeding from the marginal vessel near the cut end of the bowel.* Sutures must be taken at 3-5mm deep and 3-5mm apart using 2/0 or 3/0 absorbable polymers like Polyglactin or Polydiaxonone.
Should be done by continuous layers as it takes less time
Done with catgut
Should be done by using single layer seromuscular lambert sutures
Single layer taking submucosa.
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