Question

A 6-year-old boy experienced life threatening shock ,his CT scan showed large amount of ascites, bowel wall thickening and poor or absent enhancement of the strangulated bowel segment, showing gangrenous bowel on surgical exploration. True about anastomosis is :

• A. Should be done by continuous layers as it takes less time
• B. Should be Done with catgut
• C. Should be Done by single layer seromuscular lembert sutures
• D. Should be Done by Single layer taking submucosa

Answer 1

The Correct Option is C

In the scenario described, the boy is suffering from bowel ischemia and gangrene, which is a surgical emergency requiring bowel resection and anastomosis. In such cases, it is important to perform a meticulous surgical technique to ensure proper healing and minimize any complications.

When it comes to the anastomosis of the bowel, the method selected should provide adequate strength and allow for good blood supply to the ends being connected:

1. Continuous Layers: While faster, using continuous layers for anastomosis may not provide the necessary precision and security in ischemic conditions.
2. Use of Catgut: This is not ideal for bowel anastomosis as catgut sutures absorb quickly and can lead to insufficient wound strength.
3. Seromuscular Lembert Sutures (Single Layer): These sutures take the serosa and part of the muscularis layer, promoting effective apposition and healing while minimizing lumen narrowing. They provide strength, are more physiological, and are less likely to compromise the blood supply.
4. Single Layer Taking Submucosa: It involves deeper tissue layers and can be beneficial but may be less favorable compared to the seromuscular approach in this context due to the risk of ischemia.

Considering the delicate condition of the tissues due to gangrene, the single layer seromuscular Lembert suture is preferred. This method provides strong, secure anastomosis with minimal tissue damage, promoting optimal healing.