Length Of Suture Material Research Articles

An observational comparative study of single layer continuous extramucosal anastomosis versus conventional double layer intestinal anastomosis

Background: Conventional double layered technique of intestinal anastomosis are widely in practise. Some surgeons also practice single layer technique either continuous or interrupted. This was a prospective observational study to compare safety, efiicacy and feasibility of single versus double layered continuous techniques.Methods: Patients undergoing intestinal anastomosis with either of these two techniques were observed prospectively for various outcome parameters like length of suture material used, time taken for anastomosis, and that for entire surgery, postoperative complications, return of bowel activity etc. Data such obtained was analysed for statistical significance by applying chi-square test and unpaired ‘t’ test.Results: Length of suture used for single layer (mean of 15.06 cm) was statistically significantly lesser than that for double layer (mean 19.90 cm) (p.0.001). Time taken for anastomosis and overall surgical time too was significantly less for single layer group (p.0.001 and 0.022 respectively). Complications including anastomotic dehiscence were not significantly different between two groups. Postoperative recovery of bowel function was earlier in single layer group with marginal statistical significance (p=0.048).Conclusions: Thus in our study, single layer continuous method of intestinal anastomosis resulted in significant reduction in time, suture material length and cost; without any difference in complications and it marginally hastens the postoperative recovery of bowel function. So single layer continuous method can be recommended for intestinal anastomosis.

Continuous versus interrupted sutures for repair of episiotomy using monofilament versus synthetic absorbable multifilament suture materials: a randomized controlled trial

Objective To compare different repair techniques and different suture materials for episiotomy. Background Care of the perineum during and after childbirth has been a topic of considerable interest to all involved for many years. A considerable amount of research has been carried out in the area of perineal care, particularly in relation to the practice of performing episiotomy and to the methods of suturing. Patients and methods A total of 90 primigravidae were admitted for labor and underwent a mediolateral episiotomy after vaginal delivery. They were randomly allocated into four groups in which continuous and interrupted episiotomy repair techniques were performed under two different types of suture materials, that is, monofilament type in the form of poliglecaprone 25 and multifilament type in the form of polyglactin 910. Perineal pain during different activities on the first and seventh day postpartum was questioned by visual analog scale, and the presence of perineal pain after 3 months of delivery, repair time, amount of suture material, and episiotomy complications were investigated in each group. Results The results of the present study showed that the assessments of pain in the first day and after 1 week in movement, repose, sitting, urination, and defecation were insignificant regarding suture techniques and suture materials. The repair time and the length of suture material were statistically less in the continuous technique groups. The type of suture material did not show significant effect on either the length of suture material used or the episiotomy repair time. Conclusion The use of continuous technique of episiotomy repair is better than interrupted technique, because the former is quicker and cheaper as less suture material is used with no differences on either short-term or long-term morbidity.

Evaluation of three ligatures in simulated equine open castration.

To compare three surgical knots for preventing leakage from the vascular bundle during ligation in simulated equine open castrations. Randomized, case-control, in vitro study. Testes (N = 60) collected from 30 horses. Testes were collected from 30 horses and randomly assigned to one of three groups: group G (friction, giant knot), group T (modified transfixing knot), or group S (sliding, strangle knot; n = 20/group). The assigned knot was used to ligate the vascular bundle during open castration. The length of suture material used and the leak pressure of the testicular artery were measured and compared between groups. Strangle knots consistently leaked at higher pressures (median, 735.5 mm Hg; interquartile range [IQR], 735.5-735.5) compared with giant (median, 441.3 mm Hg; IQR, 367.8-643.6) and transfixing (median, 419.2 mm Hg; IQR, 323.6-643.6; P < .0001) knots. Both the strangle (median, 5 cm; IQR, 4.5-5.5) and giant (median, 6 cm; IQR, 5.35-6.075) knots required less suture material compared with the transfixing (median, 9.2 cm; IQR, 8.425-10.38; P < .0001) knot. The three surgical knots tested withstood pressure well above physiological levels in simulated open castrations. The strangle knot withstood higher pressure and required similar (giant) or less (transfixing) suture material than the other two knots. This study provides evidence to support the use of a strangle knot to ligate the vascular bundle during simulated open castrations in horses.

Ex vivo comparison of barbed and unbarbed sutures for the closure of caecal and pelvic flexure enterotomies in horses.

In this study the caecum and large colon were harvested from 24 slaughtered horses. On each sample, an 8‑cm long enterotomy was performed. Enterotomies were closed using either barbed or unbarbed glycomer‑631. We compared the time to close, appearance, length of suture material, bursting pressure, and costs associated with each type of material. Our findings demonstrated that time to close was significantly shorter (caecum, P = 0.034; pelvic flexure, P = 0.039) using barbed sutures (caecum 610.4 seconds; pelvic flexure 699.3 seconds) than unbarbed sutures (caecum 661.0 seconds, pelvic flexure 743.1 seconds). The length of suture material used was significantly less (caecum, P < 0.0001; pelvic flexure, P < 0.0001) with barbed (caecum 28.1 cm, pelvic flexure 32.0 cm,) compared with unbarbed sutures (caecum 41.6 cm; pelvic flexure 46.6 cm). There were no significant differences in bursting pressure (caecum, P = 0.294; pelvic flexure, P = 0.430) between barbed (caecum, 172.5 mmHg, pelvic flexure, 188.9 mmHg) and unbarbed sutures (caecum 178.3 mmHg, pelvic flexure 183.3 mmHg). The cost was higher using barbed sutures. However, the use of barbed sutures was faster, left less suture material in the tissue, and sustained comparable bursting pressure to unbarbed sutures. We therefore conclude that barbed sutures are a valid alternative to unbarbed sutures for closing large intestine enterotomy in horses.

Comparison of interrupted-X technique closure versus conventional continuous closure of rectus sheath: a randomized control study

Background: A major surgical complication after emergency midline laparotomy is abdominal fascial dehiscence. Dehiscence is associated with increased morbidity and mortality rates up to 30%, prolonged hospital stay, and a long-term risk of developing incisional hernia. The risk factors of Wound dehiscence can surgeon factors or patient factors. This study was aimed at comparing effectiveness of interrupted-X technique versus conventional continuous closure of rectus sheath in midline laparotomy in emergency setting.Methods: This study was conducted in a total of 100 patients underwent midline laparotomy for perforation peritonitis in emergency setting. Out of which 50 patients underwent rectus sheath closure by interrupted-X technique (group A) and 50 patients by conventional continuous closure (group B) using non-absorbable, monofilament, no.1 polypropylene suture. Necessary preoperative patient data, wound length, the time taken for rectus closure, length of the suture material used, post-operative complications like wound dehiscence, surgical site infection, period of hospital stay were recorded for analysis.Results: Preoperative patient data among both the groups were comparable. Group A was found to have less wound dehiscence (p=0.001 for partial and p=0.008 for complete) and less period of hospital stay (p=0.054), which were statistically significant. Surgical site infections were similar in both groups. Group B was found to have less time taken for closure (p=0.003) and less length of suture material used (p=0.003), which were statistically significant.Conclusions: Interrupted-X technique of rectus sheath closure reduces the rate of wound dehiscence and period of hospital stay, although it consumes more length of suture material and more time for suturing as compared to conventional continuous closure.

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration.

In equine castration, application of a ligature on the spermatic cord to prevent complications such as haemorrhage and evisceration has been reported with controversial results. Characteristics of commonly used knots have not been studied. To compare the modified transfixing and giant knots and the emasculator in open and closed equine castration techniques. Ex vivo experiment. A total of 144 testicles were randomly assigned to 2 groups for open or closed castration. Both groups were divided into 3 subgroups of 18 specimens each: emasculator only, emasculator plus giant knot and emasculator plus transfixing knot and the open castration group also contained 2 further subgroups of 18 testicles each: giant knot only and transfixing knot only. The length of suture material used was measured for each knot and the leaking pressure of the testicular artery measured using dye injection. In the closed castration group, parietal tunic tensile strength was measured with a tensiometer. Leaking pressure was higher in open compared with closed castration, with no significant difference among subgroups. In the closed castration group, minimum leaking pressure for the emasculator plus transfixing knot and emasculator only subgroups were close to standard physiological arterial pressures. The giant knot required less suture material than the transfixing knot. Parietal tunic tensile strength was higher when ligatures were applied. The giant and transfixing knot techniques have comparable haemostatic capability and parietal tunic tensile strength, but the giant knot requires less suture material. In open castration, using the emasculator alone may produce adequate haemostasis. In closed castration, using the giant knot in combination with the emasculator increases the bursting pressure and possibly reduces the incidence of haemorrhage. In closed castration, application of a ligature may reduce the risk of evisceration.

Comparative study of efficacy of modified continuous smead-jones versus interrupted method of midline laparotomy fascial closure for contaminated cases

Background: Mass closure of midline laparotomy fascial wound is undoubtedly superior to layered closure technique. For elective surgeries continuous method is recommended over interrupted to avoid wound dehiscence, but controversy exists in the literature about the best method of midline fascial suturing in contaminated cases. Thus this is the study to compare two techniques of closure.Methods: Prospective non-randomised study. Two groups are study group who underwent modified smead-Jones method of fascia closure and control group who underwent interrupted closure. Outcome parameters studied were time required for closure, length of suture material needed, postoperative wound infection and wound dehiscence. Data was analysed statistically using Chi-square test.Results: Time required for study group was significantly lesser than control and the length of suture required was also significantly less. Wound infection rate in study group was lesser than control but the difference was statistically insignificant (p &gt;0.05). Wound dehiscence rate was significantly less in the study group (p &lt; 0.05) compared to control group.Conclusions: In Smead-Jones method of closure tension between two loops is distributed in such a way that the fascial edges are well approximated. Originally described method was interrupted. Continuous method has advantage of being faster and has less risk of wound dehiscence due to dynamic distribution of increased tension in postoperative period due to see-saw effect. We proposed modification of original Smead-Jones technique by doing it in continuous manner to increase the benefits and found this method to be fast, cost-effective, equally effective in controlling wound infection and better than interrupted technique to prevent wound dehiscence.