Visceral and parietal suture in abdominal surgery

Area of Science:

• Surgical Techniques and Wound Healing
• Gastrointestinal Surgery
• Clinical Trials in Surgery

Background:

• Suture techniques significantly influence the healing of intestinal and other alimentary anastomoses.
• Controlled clinical comparisons are crucial for evaluating the efficacy of different surgical methods.
• Understanding optimal suture strategies is vital for minimizing complications like anastomotic dehiscence.

Purpose of the Study:

• To review the effects of various suture techniques on intestinal and alimentary anastomosis healing.
• To compare the outcomes of different suturing methods in small bowel, colonic, and colorectal anastomoses.
• To discuss methods for evaluating abdominal wound closure techniques through controlled clinical trials.

Main Methods:

• Review of controlled clinical comparisons of different suture techniques for alimentary anastomoses.
• Analysis of data from author's and other workers' studies on inverting versus everting techniques.
• Discussion of methodologies for controlled clinical trials assessing parietal abdominal wound closure.

Main Results:

• In small bowel and colonic anastomoses with a peritoneal coat, inverting suture techniques are more secure than everting techniques.
• For low anterior resections lacking a distal peritoneal coat, a one-layer, slightly inverting technique reduces dehiscence compared to two-layer methods.
• Continuous layer suture with chromic catgut is inferior for abdominal wound closure compared to tension sutures or wire figure-of-eight sutures.

Conclusions:

• The choice of suture technique, particularly inverting versus everting and one-layer versus two-layer, significantly impacts anastomotic healing and complication rates.
• Specific anatomical considerations, such as the presence or absence of a peritoneal coat, dictate the optimal suture strategy for gastrointestinal anastomoses.
• Controlled clinical trials are essential for establishing evidence-based practices in surgical wound closure and anastomosis.