An alternative asymmetric figure-of-eight single-layer suture technique for bowel anastomosis in an in vitro porcine model

Abstract

Anastomotic techniques are of vital importance in restoring gastrointestinal continuity after resection. An alternative asymmetric figure-of-eight single-layer suture anastomotic technique was introduced and its effects were evaluated in an in vitro porcine model. Twelve 15-cm grossly healthy small intestine segments from a porcine cadaver were harvested and randomly divided into asymmetric figure-of-eight single-layer suture (figure-of-eight suture) and single-layer interrupted suture technique (interrupted suture) groups (n = 6 in each group). The anastomosed bowel was infused with methylene blue solution to test anastomotic leakage. Anastomosis construction time, leakage, and suture material cost were recorded and analyzed statistically using Fisher's exact test and Student's t-test. One anastomotic leakage occurred (16.67%) in the figure-of-eight suture group, and two (33.33%) in the interrupted suture group (p > 0.9999). The anastomosis construction time was relatively short in the figure-of-eight suture group, but the difference did not reach a statistically significant level between the two groups. The mean number of suture knots and the cost of suture material in the figure-of-eight suture group were significantly decreased in comparison to the interrupted suture group (15.67 ± 3.30 vs. 22.17 ± 2.03, 167.11 ± 35.20 vs. 236.45 ± 21.70 CNY, p < 0.01, respectively). Our results suggested that the alternative asymmetric figure-of-eight suture technique was safe and economic for intestinal anastomosis. An in vivo experiment is required to elucidate the effects of this suture technique on the physiological anastomotic healing process.

Asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis: A preliminary study

“…Our results showed that the mean anastomosis time was significantly shortened in the asymmetric figure-of-eight single-layer suture technique group than in the single-layer interrupted sutures group, partly owing to the requirement of fewer knots (17). Time-saving is also important for patients who experience severe complications pre-or intraoperatively, such as intestinal volvulus and shock.…”

“…Patients were divided into two groups: the single-layer asymmetric figure-of-eight suture technique group (group 1) and the traditional suture technique, i.e., single-layer interrupted sutures, group (group 2) ( 9 , 10 , 20 , 21 ). The single-layer asymmetric figure-of-eight suture technique has been described in detail by Liu et al ( 17 ). To summarize, an absorbable surgical suture (4–0 or 5–0 Ethicon) was used for anastomosis.…”

“… A schematic representation of the asymmetric figure-of-eight suture. The technique has been described in detail previously ( 17 ). …”

“…Thus, some patients may have to face several possible complications arising from multiple procedures. Herein, we modified an asymmetric figure-of-eight single-layer suture technique on the basis of an abdominal wall closure technique described by Höllwarth ( 16 ) and an in vitro porcine experimental finding ( 17 ). The asymmetric figure-of-eight single-layer suture technique has some advantages; it is easy to perform, is time-saving, and has better mucosal apposition ( 17 ).…”

“…Herein, we modified an asymmetric figure-of-eight single-layer suture technique on the basis of an abdominal wall closure technique described by Höllwarth ( 16 ) and an in vitro porcine experimental finding ( 17 ). The asymmetric figure-of-eight single-layer suture technique has some advantages; it is easy to perform, is time-saving, and has better mucosal apposition ( 17 ). We piloted the modified suture technique by performing intestinal anastomoses, especially in the bowels with a pathological status in pediatric patients.…”