[Application of inner figure-of-eight suture to laparoscopic colorectal surgery]

Regardless of laparoscopic or open colorectal surgeries, intestinal anastomosis is usually an important operative procedure. Even if stapler is widely used in different intestinal surgery nowadays, hand sewn suture is an indispensable procedure in clinical practice, meanwhile after stapled anastomosis, additional hand sewn suture is usually performed to ensure the safety of anastomosis. The inner figure-of-eight suture is a single layer suture technique which has been widely used in skin, tendon, rectus and uterus for quick and secure approximation. We describe our innovative application of inner figure-of-eight suture technique for intestinal anastomosis and/or reinforcement after stapled anastomosis in laparoscopic colorectal surgery. Main steps of inner figure-of-eight suture for intestinal anastomosis on posterior wall are as follows: (1) At 4 mm from cut edge of bowel, needle enters vertically from one side and courses mucosa-serosa-opposite serosa-mucosa in parallel to the entry point. (2) The needle is brought back to first entry side of bowel at 45 degree to enter the mucosa 5 mm below the first entry point and out on opposite side mucosa horizontally. (3) Both lose ends of the suture are pulled to approximate bowel edges and knots are tied on mucosal surface, in which suture line presents figure-of-eight on mucosal surface and two parallel suture lines are seen on serosal surface. When inner figure-of-eight suture is performed on anterior wall, the procedure is similar, but needle passes from serosa-mucosa-opposite mucosa-serosa and repeated to complete the inner figure-8 suture and knots are tied on serosa. The final look is two parallel sutures at 0.5 mm in between and the figure-of-eight remains inside the lumen. We did not deliberately try to invert the bowel edges, and if anastomosis is not satisfactory at final examination, simple interrupted seromuscular suture can be carried out. From 2015 till now, we have successfully completed inner figure-of-eight sutures in 38 cases receiving intestinal anastomosis reinforcement procedure and in 24 cases receiving hand sewn anastomosis. Comparison study revealed inner figure-of-eight suture presented shorter anastomotic time and less medical cost without anastomotic leakage, stump leakage or bleeding. No anastomotic stenosis was found at enteroscopy examination during follow up. We think that inner figure-of-eight suture possesses safe and simple advantages and is a manual suture technique worthy of promotion.