Single layer anastomosis in the upper gastrointestinal tract.

A total of 466 single layer upper gastrointestinal anastomoses were made in 349 patients during an 11-year period. Six (1.3 per cent) anastomoses leaked. Radiological leakage was seen in one of 24 (4.2 per cent) oesophagogastric/jejunal anastomoses. There were no leaks after 66 gastrojejunal anastomoses; one of 84 (1.2 per cent) gastroduodenal anastomoses leaked and was converted to a gastrojejunal anastomosis. Two of 121 (1.7 per cent) biliary-enteric anastomoses leaked and both were successfully managed without reoperation. Two of 171 (1.2 per cent) enteroenteric anastomoses leaked, both in patients with established intraperitoneal sepsis which proved fatal. Of the 349 patients, 13 (3.7 per cent) died in hospital or within 30 days of operation but in only two was anastomotic leakage implicated. Single layer appositional upper gastrointestinal anastomoses are simple, safe and economic.