Influence of suture technique on anastomotic leakage rate—a retrospective analyses comparing interrupted—versus continuous—sutures

Abstract

While many hospitals consider a continuous sutured colonic anastomosis with monofilamental fiber the current state of the art, others have advocated for interrupted sutures as the gold standard. The aim of the study was to evaluate the influence of suture technique on leakage rate (primary endpoint), wound infections, postoperative stay, and mortality. Retrospective analyses of 347 patients (273 elective, 74 urgent) over 6years with a handsewn colonic anastomosis (190 interrupted, 157 continuous), excluding sigma and rectum anastomosis. Demographic and surgical baseline characteristics were used as competing predictors. Overall leakage rate was 9% but strongly dependent on suture technique (interrupted: 16%; continuous: 2.5%; p = 0.001) yielding an odds ratio of 5.10 [95% CI: 2.55, 6.71] (relative risk of leakage). No other variable showed a significant influence on leakage rate. Postoperative stay was prolonged in the interrupted suture group (23 ± 15 vs. 16 ± 11days; p = 0.000, attributable effect 7.5days [4.7, 10.3]). Our results indicate a highly significant reduction of anastomotic leakage rate and postoperative stay that generalize to the underlying population by continuous sutures in handsewn colonic anastomosis. In the absence of randomized prospective studies, the current results provide the yet strongest evidence for the superiority of continuous sutures.