Despite the Effects of Tension and Intraluminal Pressure, Which Suture Technique Is the Most Appropriate for Prevention of Air Leakage or Anastomotic Dehiscence in Tracheal Anastomoses in the Short Term? An Experimental Research on Ex Vivo Model.

Abstract

Purpose: We performed an experimental study comparing different suture techniques in trachea anastomoses using the ex vivo sheep model, which deals with the parameters that suture tension, air leakage, intraluminal pressure, and tension at which the anastomosis will rupture. We aimed to find an answer to “Which suture technique should be used in tracheal anastomoses?”Methods: In all, 45 sheep tracheas were randomly divided into three groups (each n = 15) differing in suture technique for anastomoses: single stitches, mixed, and continuous suture. The anastomoses were evaluated for air leakage under normal (25 mbar) and high (70 mbar) intraluminal pressures without tension. Then, air leakage was followed under high intraluminal pressure with tensile stress. Tension levels of dehiscence were also recorded. Data were statistically evaluated.Results: No air leakage was observed at 25 mbar intraluminal pressure. At 70 mbar pressure without tension, no statistically significant difference was found among the groups (p >0.05). However, single-stitch technique was the best in terms of air leakage tension and rupture tension levels (p <0.05).Conclusion: The most reliable and advantageous is single-stitch technique for a tracheal anastomosis in short-term results. Further studies are needed to analyze longer ventilation periods in terms of other serious complications as ischemic dehiscence and stenosis.