Cystotomy Closure: A Comparison of the Strength of Appositional and Inverting Suture Patterns

Abstract

Dorsal cystotomies were performed in 60 healthy dogs. Twenty bladders were closed with a single-layer interrupted appositional suture pattern, 20 with a two-layer interrupted appositional suture pattern, and 20 with a two-layer continuous inverting suture pattern. Four dogs from each group were euthanatized at hours 0, 3, 12, 18, and 24. Mechanical strength of the cystotomy closures was evaluated by calculating the circular bursting wall tension. The single-layer interrupted appositional suture pattern was as strong as both two-layer suture patterns at hours 3, 12, 18, and 24. The two-layer interrupted appositional suture pattern was as strong as the two-layer continuous inverting suture pattern during the first 24 hours.

Comparison of Two Laparoscopic Suture Patterns for Repair of Experimentally Ruptured Urinary Bladders in Normal Neonatal Calves

“…Subsequently, experimental studies in dogs evaluated a 1‐layer appositional pattern for cystotomy closure: a 1‐layer appositional pattern was as strong as a 2‐layer continuous inverting suture pattern within the first 48 hours post‐operatively 28 . Currently, a 1‐layer, appositional closure technique is recommended for cystotomy closure in dogs and humans 29,30 .…”

“…Determination of the BS to test surgical repair of hollow muscular organs is clinically relevant as it is the force of distension that will rupture the incision line and cause leakage 28 . BS may be expressed as either the bursting pressure or the circular bursting wall tension 28 .…”

“…Determination of the BS to test surgical repair of hollow muscular organs is clinically relevant as it is the force of distension that will rupture the incision line and cause leakage 28 . BS may be expressed as either the bursting pressure or the circular bursting wall tension 28 . Bursting pressure is the intra‐luminal pressure at which leakage occurs and is independent of the size and shape of the structure being tested 28 .…”

Experimental Evaluation of Urinary Bladder Marsupialization in Male Goats

“…Radasch et al (1990) observed that nonincisional rupture of urinary bladders occurred by mucosal tearing followed by dissection of urine through the bladder wall until it extruded through the serosa. Similar findings were observed during abdominal exploration of several clinical cases at the Virginia-Maryland Regional…”

Suture patterns

“…Inverting suture patterns have been traditionally described for the closure of hollow viscera. However, studies have shown no added benefit of using inverting suture patterns on routine closure of hollow viscera, and have even documented a delay in healing when compared to appositional suture patterns (Radasch 1990). An inverting pattern can sometimes be quite useful, for example to invaginate a section of stomach wall when managing a patient with gastric dilatation and volvulus whose gastric mucosal viability is questionable.…”