Single-Layer End-to-Side IleotransverseAnastomosis in Emergency RightHemicolectomy: A Comparative CohortStudy on Anastomotic Leakage and Mortality

Abstract

Introduction: Acute intestinal obstruction due to right-sided colorectal pathology is a high-risk emergency. Delayed presentation, bowel dilation, microbial contamination, impaired microcirculation, and limited preoperative optimization increase the risks of anastomotic failure, sepsis, and mortality. Although leakage after emergency right hemicolectomy
ranges from 8% to 15% (up to 18–20% in high-risk settings), and mortality often reaches 10–20%, the optimal ileotransverse anastomosis remains debated. This comparative cohort study (January 2020–January 2026) evaluated whether optimized small bowel–large bowel reconstruction improved outcomes. Methods: This comparative cohort study was conducted at the Department of Faculty Surgery, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan. Data were collected
from January 2020 to January 2026 for this study. The study included 97 patients who underwent emergency surgery for acute intestinal obstruction requiring ileotransverse anastomosis. The etiologies were predominantly malignant (6.1% benign cases). The study group (n = 35) underwent right hemicolectomy with original single-layer continuous inverting end-to- side ileotransverse anastomosis using a 3-0 absorbable suture and vascularity-oriented stump preparation (Moynihan-shaped
colonic stump at 60°; ileal stump prepared by removing the anti-mesenteric angle; colonic opening along the tenia libera) to minimize trauma. Results: The comparison group (n = 62) underwent conventional two-layer hand-sewn side-to-side anastomosis (inner continuous 3–0 polyglycolide, outer interrupted 3–0 nylon). All patients had radiographic obstruction;
symptoms exceeded 48 h in most cases and 4 days in 40% of cases, with surgery performed 4–16 h post-admission via midline laparotomy. Anastomotic leakage occurred in 0/35 versus 9/62 (14.5%; P = 0.024), and mortality in 0/35 versus 4/62 (6.4%; P = 0.041); the mean hospital stay was similar (19.5 vs. 19.9 days; P = 0.731). Conclusion: These findings suggest that a single- layer end-to-side technique emphasizing preserved vascular architecture and reduced suture-related ischemia can decrease leakage and early mortality in emergency right-sided obstruction, supporting broader prospective multicenter studies.