Suture Line Research Articles

The Effect of Gluing Versus Suturing of the Stapler Line in Sleeve Gastrectomy on Weight Loss.

Stapler line reinforcement during sleeve gastrectomy (LSG) was assessed thoroughly in the context of postoperative complications focusing on leakage and bleeding. However, the effect of stapler line reinforcement techniques on the short- and long-term weight loss is still unclear and lacking. We hypothesize that inverting of the stapler line by Lembert suturing could lead to further additional reduction of the remnant gastric volume and accordingly a more significant weight reduction. Retrospective analysis of patients that underwent LSG (2012-2018) from the two university hospitals. The first hospital routinely performed oversewing with inversion of the stapler line (first group, Lembert suture), while the second university hospital performed LSG without stapler line oversewing and inversion, but routinely used VeraSeal glue (second group, non-Lembert); both groups were compared in terms of weight loss and complications. Four hundred eighty and 550 patients underwent LSG in the first and second hospital, consequently. The mean BMI change and EBWL at 1, 3, and 5 years were better in the first group than in second group. The mean last follow-up BMI was significantly lower in Lembert group (29.8 ± 5.2kg/m2) than in non-Lembert group (32.9 ± 6.7 kg/m2), P = 0.001. The mean EBWL at last follow-up point was significantly better for the Lembert group as compared to non-Lembert group (73.7 ± 26.59 versus 57.12 ± 27.71, P = 0.001). Lembert suture line oversewing and inversion in LSG is associated with noticeable improvement in weight loss outcomes at 1, 3, and 5 years and last follow-up compared to LSG with VeraSeal gluing.

Universal intestinal suture in rehabilitation of patients with single-layer anastomoses after elective upper gastrointestinal tract surgery

To evaluate universal intestinal suture in rehabilitation of patients with single-row anastomoses after elective upper gastrointestinal tract surgery. A single-center study included 142 patients over 8-year period. There were 72 (50.7%) pancreaticoduodenectomies and 70 (49.3%) gastric resections and gastrectomies. The rehabilitation program included single-layer anastomoses using universal intestinal suture, intestinal drainage for decompression and enteral nutrition, therapeutic and diagnostic endoscopy to stimulate motor evacuation function, patency of anastomoses and assessment of anastomositis. Intestinal drainage for decompression and enteral nutrition was used for 6 (4; 7) days after surgery. Intraluminal endoscopy was performed after 9 (7; 11) days. In patients with anastomositis grade 0 (26.5%) and 1 (62.4%), we observed minimal inflammation along intestinal suture line (mean hospital-stay 16 (13; 20) days). In patients with anastomositis grade 2 (8.5%) and 3 (2.6%), we observed surface erosions and ulcers in the anastomosis zone (mean postoperative hospital-stay 20 (16; 27) days). Postoperative complications unrelated to anastomoses were diagnosed in 17.6% of cases; 12% of patients underwent redo surgery. Mortality rate was 2.8%. Universal intestinal suture in rehabilitation of patients with single-layer anastomoses contributed to uncomplicated healing of anastomoses in 88.9% of patients with anastomositis grade 0-1 and reduced the incidence of anastomositis grade 2-3 to 11.1%, as well as hospital-stay after elective upper gastrointestinal tract surgery.

Failing DeVega tricuspid valve repair due to detachment of annuloplasty sutures: The Bowstring (Guitar string) sign.

The DeVega annuloplasty procedure involves a double-running suture line along the circumference of the tricuspid annulus, encircling the anterior and posterior leaflets. A rare mechanical complication of this technique is the detachment of the suturing from the annulus, which can be referred to as the "bowstring sign" or "guitar string sign."

“A Bridge-over-the Bar”: A Novel Strategy to Prevent Paravalvular Regurgitation during Mitral Valve Replacement for Severe Mitral Annular Calcifications

Mitral annular calcifications have been known to increase complexity during mitral valve replacement (MVR). Standard procedure requires decalcification followed by reconstruction of the mitral annulus prior to placing the prosthesis. While this is the ideal technique, it is not feasible in every patient due to the associated risks. The mere attempt at valve replacement without proper annular decalcification has been associated with a high incidence of periprosthetic leak which complicates the postoperative course and has been associated with increased morbidity and mortality. With the advances in transcatheter therapy, postoperative periprosthetic regurgitation can be managed with devices and primary transcatheter valve implantation could be alternative to standard valve replacement; however, these alternate strategies are not without its own limitations and drawbacks. In the current report, we present a novel strategy to be used in a select group of patients with severe but non-circumferential annular calcifications to prevent/minimize periprosthetic regurgitation during MVR. This involves placing a patch over the posteriorly located calcium bar, thus minimizing tension on the posterior suture line and contain any periprosthetic regurgitation if to develop. This modification has been performed in a total of nine cases with acceptable early results.

“C-shaped” anterolateral thigh flap for stomal repair due to recurrence in patients with total laryngectomy

Background: Stomal recurrence after total laryngectomy is one of the most challenging problems in head and neck surgery due to the complexity of its management. The tracheal opening remains deep and caudal after resection, creating a neo stoma that presenting a significant challenge for reconstructive surgery. With this study, we aimed to describe the design of the C-shaped ALT flap to show that it is the ideal design in such a difficult reconstruction. Methods: Five patients who underwent a free ALT flap for defects in the anterior neck wall and airway after resection due to tumor recurrence adjacent to a permanent stoma between 2018-2020 were included in the study. Tumor resection was performed by the Otolaryngology team in all cases. Age, gender, cause of defect, ALT flap size, donor site closure method, number of perforators, ischemia time, flap survival, early complications, and postoperative tracheostomy use and postoperative quality of life assessment were reviewed. Results: 5 male patients were included in the study and the mean age was 63.8. The mean duration between admission and recurrence after laryngectomy was 11.2 months. Flap survival was noted in all patients. The patients did not encounter complications such as tracheostomy-related dehiscence, discharge, fistula, cannulation difficulties due to flap collapse, and mediastinitis during their lifetime. In the follow-ups, one still alive, the mean survival time of the other three patients was four months. We found an average high score in our patients regarding functional scales in QLQ-H&N35 module. Conclusions: The C-shaped ALT flap design provides ease of insertion into a tension-free tracheal-skin suture line and helps to reduce the rates of stoma-related complications and increase the quality of life of the patients.

Short Term Outcomes of Fistulectomy with Primary Closure of Internal Opening for the Treatment of High Trans-sphincteric Fistula in Ano

Background: Fistulectomy with primary closure of the internal opening has been used to treat high trans-sphincteric fistula in ano. This method entails complete removal of the fistula tract from external opening to internal opening and closing the internal opening from the inside of anal canal. This study aims to assess the outcomes of fistulectomy with closure of the internal opening for high trans sphincteric fistula. Methods: Observational study was carried out in the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Total 36 patients with high trans sphincteric fistula were included in this study. After preoperative MRI of anorectum, fistulectomy with closure of the internal opening was done. Results: The mean age was found 39.4 years with range from 20 to 57 years. Among 36 patients, 83.3% patients had primary wound healing within 6 weeks and rest of the patients healed within 10 weeks. Clinical squeeze pressure was reduced in 11.1% patients. Thirty two patients were available for 1 year follow up. Recurrence occurred in 21.88% (n=32) patients within the study period. 91.7% patients had Park-Brown continence grade-A and 8.3% had grade-B. Wound infection did not impair postoperative continence (p>0.05). There was statistically significant difference between wound infection and suture line dehiscence with fistula recurrence (P<0.05). Conclusion: Since the recurrence and incontinence rate were low, clinical squeeze pressure did not significantly reduced along with quick healing rate, fistulectomy with closure of the internal opening is an effective treatment option for high trans-sphincteric fistula in ano.

Residual gastric cancer above the suture line that was successfully resected en bloc by ESD

Residual gastric cancer above the suture line that was successfully resected en bloc by ESD

Barbed Versus Conventional Sutures in Laparoscopic-Assisted Colorectal Surgery: A Systematic Review and Meta-Analysis.

Background: Minimally invasive surgery is the preferred method for treating colorectal disease. Laparoscopic suturing is complex, and barbed sutures (BS) can improve the process by eliminating the need for surgical knots and constant traction on the suture line. This study compares intraoperative and postoperative outcomes in patients undergoing laparoscopic-assisted colorectal surgery (LCS) with anastomosis using BS and conventional sutures (CS). Methods: PubMed, Scopus and Cochrane Library were systematically searched for studies comparing BS to CS in patients undergoing LCS. Continuous outcomes were compared using mean differences (MDs), and odds ratios (ORs) were computed for binary endpoints with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.2.3. Results: A total of four studies comprising 285 patients were included, of whom 143 patients (50.17%) underwent BS. Compared with CS, BS significantly reduced the total operative time (MD -16.25 minutes; 95% CI: -25.94, -6.56; P < .01; I2 = 0%). However, there were no significant differences between groups in the occurrence of intraoperative complications (OR .74; 95% CI: .26-2.12; P = .58; I2=0%), anastomotic leakage (OR 1.00; 95% CI: .14-7.26; P = 1.00), and Clavien-Dindo ≥III complications (OR 1.80; 95% CI: .41-7.95; P = .44, I2 = 0%). Conclusion: In this meta-analysis, BS significantly reduced the operative time in the anastomotic closure compared to CS in LCS. Furthermore, there were no significant differences between the groups in anastomotic leakage, intraoperative complications, and severe postoperative complications.

Evaluation of the safety and effectiveness of easyEndo™ universal stapler compared with easyEndo™ E-lite in patients submitted to gastric surgery: a retrospective/prospective study including a large number of patients

Background: Staple line complications represent the most dangerous complication after gastric surgery. Better-formed staples could potentially reduce complications postoperatively. The newer motorized generation stapling system would lead to fewer intraoperative staple line complications compared to traditional stapling systems. Purpose was to evaluate the safety and efficacy of these two types of stapler models by determining its intraoperative performance and peri-operative complications. Methods: It was an observational cohort study including a total of 3613 patients submitted to gastric surgery for benign or malignant disease. The study was conducted within two periods: stage A using easyEndoTM universal (n=2359 patients, from January 2017 to December 2022) and stage B (n=1254 patients, from January 2023 to June 2024) using easyEndoTM E-lite motorized stapler including obese patients (n=3239), benign diseases with indication of surgical treatment (n=268) and patients with gastric cancer (n=106). Results: Although higher rate of leaks and postoperative complications were observed in patients submitted to sleeve gastrectomy or gastric bypass during stage A compared with stage B (p=0.0025), both type of staplers are safe and effective for performing gastric surgery. In patients submitted to gastric resections, no significates differences were demonstrated in terms of postoperative complications comparing the two groups (p=0.1). Conclusions: Patients operated on using motorized stapler presented less suture line interventions but no differences regarding postoperative complication. The results confirmed data published in previous reports and meta-analysis, but now including a big number of patients and complex procedures.

Surgical site infection following incisional negative pressure wound therapy in lower limb amputation closure: A randomized controlled trial.

Major amputations are a standard procedure being done for various etiologies of the lower limb. Surgical site infections often complicate the postoperative outcome of patients. Negative pressure wound therapy has evolved to have a preventive role in SSI. According to the best of our knowledge, this is the first study that compared the wound and overall outcomes of incisional application of NPWT against standard dressing in patients undergoing stump closure following major lower limb amputations. The primary goal was to compare the rate of surgical site infections. The secondary objectives were to compare the postoperative hospital stay, reinterventions, readmission, and mortality. A randomized controlled trial was conducted in a healthcare institute and included 62 patients who underwent closure of major lower limb amputation stumps. After stump closure, patients were randomized into iNPWT and standard groups for the dressing over the suture line. Surgical site infection and other outcomes were assessed. A statistically significant difference was found in the rate of surgical site infection (16% vs 51%, P = 0.003). Also, it appreciated a significant reduction in the number of patients needing reinterventions (26% vs 52%, P = 0.037) and the duration of postoperative hospital stay (5.8 days vs 8.2 days, P = 0.043) in the iNPWT group. Incisional application of NPWT following lower limb amputations is an effective tool to reduce surgical site infections, the need of multiple reinterventions, the cost of treatment, and hospital stay. We should use this special dressing as a standard protocol for the high-risk patients undergoing stump closure following major amputations; therefore, it can reduce the morbidity of patients.

Revision Surgery for Scar Contracture and Web Creep after Syndactyly Release.

Background: Revision surgery after syndactyly separation is challenging. Web creep and scarring have a great impact on function and appearance of the hand. There is a paucity of literature on revision surgery for syndactyly. The aim of this study is to present the outcomes of revision surgery for syndactyly. Methods: This retrospective study included patients who required revision surgery after syndactyly release for web creep, scar contracture affecting motion and/or bony deformities. Web creep was graded using the Withey classification and scars were graded as minimal, mild, moderate and severe based on the impact on range of motion (ROM). All patients underwent dorsal and volar triangular flaps for correction for web creep, multiple Z-plasty and/or proximal interphalangeal joint (PIPJ) release for correction of scar contractures and osteotomy for correction of angular/rotational bony deformities. Improvement in web creep grading, scar contracture and change in angular and/or rotational deformities were recorded. Results: The study included 9 hands in 7 patients who required surgery for 13 web creeps (four grade 2, four grade 3 and five grade 4), 20 scar contractures (five mild, seven moderate and eight severe), 6 angular (five ≤15° and one = 40°) and 1 rotational deformity. All web creeps improved to grade 1. Out of the 20 scar contractures, 14 improved to mild and 6 to moderate. Two patients underwent corrective osteotomy, one for rotational deformity and one for a 40° angular deformity which improved to 5°. Conclusions: Double opposing triangular flap presents a good option for revision of the web with no recurrence of web creep after a 1-year follow-up period. We suggest a grading system which assesses the effect of scarring on finger motion. Finally, avoiding straight volar suture lines decreases the incidence of recurrence. Level of Evidence: Level IV (Therapeutic).

Indocyanine green fluorescence angiography in the management of intestinal injuries following penetrating abdominal trauma: a case-control study comparing postoperative outcomes.

The surgical management of penetrating hollow visceral injuries includes primary repair or exteriorization. Tissue perfusion at the site of gastrointestinal suture repair may be challenging to assess and is vulnerable to local energy transfer-related injury, micro- or macro-circulatory insufficiency, or splanchnic vasoconstriction for various reasons. Breakdown of suture lines can lead to potentially life-threatening complications. The intraoperative use of indocyanine green fluorescence angiography (ICG-FA) may reduce the risk of postoperative morbidity and mortality by ensuring optimal tissue perfusion at the chosen site of suture repair. The authors conducted a retrospective review of the postoperative complications, length of ICU stay, and length of hospital stay in patients undergoing laparotomy, with and without ICG-FA for penetrating abdominal trauma at a Level One Trauma Center in Cape Town, South Africa. One hundred patients were included in the study, of which 20 underwent laparotomy with ICG-FA, and 80 did not. The overall complication rate was significantly lower in the ICG-FA group (OR 0.336, p =0.0412). The anastomotic leak rates in the ICG-FA and control groups were 0% and 6.25%, respectively ( p =0.5799). Revision surgery was required in 2 and 14 patients in the ICG-FA and control groups, respectively (OR 0.524, p =0.516). The mean length of stay in the hospital showed no statistical difference, 8.6 and 5.3 days for the ICG-FA and control groups, respectively ( p =0.092). The mean length of ICU stay was 6.3 and 2.3 days for the ICG-FA and control groups, respectively ( p =0.1642). Lower levels of overall postoperative complications and lower rates of revision surgery in patients undergoing laparotomy with ICG-FA are promising. Non-significant findings regarding the relationship between the usage of ICG-FA and anastomotic leak rates suggest the need for larger randomized studies.

Lateral forehead flap in oral reconstruction: A case report

Introduction: Lateral Forehead flap is very versatile as it represents a good choice for reparation of different types of nose and oral cavity defects and provides an optimal, aesthetic, and functional outcome. In era of free transfer tissue, the use of loco-regional flaps, alone or in combination may prove to be the only practical solution in the absence of resources or other options. Case presentation: A-65 years old male with multiple comorbidities underwent a wide resection with adequate margin of the lower lip and small segment of the upper lip due to a locally advanced squamous carcinoma. After long consideration, the last resort was the pedicled lateral forehead flap. Information was sourced from patient’s case notes and operating theatre report. Results: The donor defect was covered with a split-thickness skin graft harvested from the right thigh area. The flap survived and both functional and aesthetic outcome were satisfactory. The site of the donor defect result was also acceptable. No complications were noted in our case study beside a small tip necrosis and breakdown of the suture line. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in cases with previous history of radiotherapy or surgery. Decision making of a particular reconstructive option should be done taking in consideration the available resources, surgical team expertise along with the patient's general condition. The pedicled forehead flap still useful when other options are inappropriate or have not been successful.

PREVENTION OF THE DEVELOPMENT OF FAILURE OF COLON ANASTOMOSES

Abstract. Objective. Development of a method to prevent the development of failure of large intestinal anastomoses. Research materials and methods. The results of treatment of 127 patients were studied. Colonic anastomosis was performed in 78 patients using a disposable double-row circular stapling device. To 49 patients was used, a disposable three-row circular anastomosis and a local hemostatic agent. Results and discussion. We have improved the method of restoring of the colon. The supporting head of the circular stapling device is placed in the proximal part of the large intestine. A pocket suture is applied and tightened. The distal end of the intestine is sutured. The suturing device is passed through the anus, the distal stump of the rectum is pierced. The Tahocomb plate is fixed on the thrust head. The ends of the intestine are sew with a three-row staple suture. The line of anastomosis is covered with a second Tahocomb plate. Conclusions. Suture line failure was 2.04% versus 3.84% of cases in the comparison group. The method is based on the synergism of the hemostatic and sealing effect of Тahokomb and the provision of mechanical tightness with the help of a three-row seam.

Current status of evaluation and treatment of early-stage remnant gastric cancer.

Because of early diagnosis and improved prognosis, patients with gastric cancer are now surviving longer and remnant gastric cancer after gastrectomy is becoming more common. Remnant gastric cancer is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. In recent years, the development of endoscopic therapy has provided us with new therapeutic ideas. Although with some drawbacks, such as limited working space, gastric fibrosis and staples under the suture line, endoscopic management is still an effective treatment option with potential long-term survival advantage. For gastrectomy patients, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the early remnant gastric cancer. This review aims to provide an overview of remnant gastric cancer, especially focusing on its pathogenesis as well as new advances in the diagnosis and endoscopic treatment of early-stage remnant gastric cancer.

The Investigation of the Effect of Boron on Intestinal Incision Wound Healing in Rats

In this study 250-300 g 38 adult male Wistar Albino rats were used, randomly divided into six groups as four groups that received boron (n=7/group) and two control groups (n=5/group). Etibor-48 (Borax pentahydrate) was diluted in saline and administered by gavage. The Boron 1 group received 10 mg/kg boron for three days and the Boron 2 group received 10 mg/kg for seven days, Boron 3 group received 30 mg/kg for three days, and the Boron 4 group, received 30 mg/kg for seven days before the start of the study. On day 0, colon incisional wound was performed for all rats under general anesthesia and sutured. Control groups took no drugs and were euthanized on the third and seventh postoperative days. Blood sampling were done via cardiac punction at necropsy to measure Interleukin-1, IL-6, TNF-α, MPO, MDA, NO, GSH, and AOA. The sutured bowel incision line was evaluated histopathologically. Inflammatory cell measurement results in Boron 1, 2, 3, and 4 groups, and Control 3- and 7-day groups were 2.93±0.41, 3.93±0.41, 3.61±0.55, 3.93±0.41, 1.26±0.41, and 1.43±0.51, respectively. There were statistical difference between the groups (P˂0.05). AOA measurement results in the Boron 1, 2, 3, and 4 groups, and Control 3- and 7-day groups were 7.38±0.64, 8.27±0.57, 9.07±1.16, 9.06±0.86, 10.00±1.47, and 9.86±0.54 mmol/L, respectively. There were statistical difference between the Boron 1 and the Control 3- and 7-day groups (P˂0.05). It is concluded that Borax pentahydrate solution 30 mg/kg had a positive effect on intestinal incisional wound healing, contrary to the literature.

Henneguya patriciai n. sp. (Cnidaria: Myxosporea) parasitizing Leporinus friderici (Bloch 1794) from Tartarugalzinho river, eastern Amazon.

The Amazon basin has the largest number of fish in the world, and among the most common fishes of the Neotropical region, the threespot (Leporinus friderici) is cited, which in relation to its microparasitic fauna, has described only 1 species of the genus Henneguya, Henneguya friderici. The Myxozoa class is considered an obligate parasite, being morphologically characterized by spores formed by valves connected by a suture line. This study describes a new species of Henneguya sp. in the Amazon region for L. friderici. This parasite was found in the host's pyloric caeca and caudal kidney, with mature spores with a total spore length of 38.4 ± 2.5 (35.9–40.9) μm; the spore body 14.4 ± 1.1 (13.3–15.5) μm and 7.3 ± 0.6 (6.7–7.9) μm wide. Regarding its 2 polar capsules, they had a length of 5.1 ± 0.4 (4.7–5.5) μm and a width of 2.0 ± 0.1 (1.9–2.1) μm in the same pear-shaped, and each polar capsule contained 9–11 turns. Morphological and phylogenetic analyses denote that this is a new species of the genus Henneguya.

Convolutional neural network-based classification of craniosynostosis and suture lines from multi-view cranial X-rays

Early and precise diagnosis of craniosynostosis (CSO), which involves premature fusion of cranial sutures in infants, is crucial for effective treatment. Although computed topography offers detailed imaging, its high radiation poses risks, especially to children. Therefore, we propose a deep-learning model for CSO and suture-line classification using 2D cranial X-rays that minimises radiation-exposure risks and offers reliable diagnoses. We used data comprising 1,047 normal and 277 CSO cases from 2006 to 2023. Our approach integrates X-ray-marker removal, head-pose standardisation, skull-cropping, and fine-tuning modules for CSO and suture-line classification using convolution neural networks (CNNs). It enhances the diagnostic accuracy and efficiency of identifying CSO from X-ray images, offering a promising alternative to traditional methods. Four CNN backbones exhibited robust performance, with F1-scores exceeding 0.96 and sensitivity and specificity exceeding 0.9, proving the potential for clinical applications. Additionally, preprocessing strategies further enhanced the accuracy, demonstrating the highest F1-scores, precision, and specificity. A qualitative analysis using gradient-weighted class activation mapping illustrated the focal points of the models. Furthermore, the suture-line classification model distinguishes five suture lines with an accuracy of > 0.9. Thus, the proposed approach can significantly reduce the time and labour required for CSO diagnosis, streamlining its management in clinical settings.

Analysis and Visualization of Inter-/Intra-surgeon Variability Using Surgical Simulation for Partial Anomalous Pulmonary Venous Connection Repair.

There may be inter-/intra-surgeon variability in the repair of congenital heart defects. The objective was to analyze and visualize inter-/intra-surgeon variability in the level of patch suture lines and in the shape and size of patches developed through surgical simulation for partial anomalous pulmonary venous connection (PAPVC) repair using a patient-specific 3D-printed heart model. A patient with PAPVC and preoperative computed tomography data were selected, and a patient-specific heart model was obtained. Two different exposures on the model were tested. Two surgeons were enrolled. Both surgeons performed a single-patch repair on four heart models with one exposure and four models with the other. On the potential suture line, 20 points common in each model were allocated. The level of patch suture lines was represented as a deviation from the 20 points. The shape and size of the patches were analyzed and visualized using geometric morphometrics approaches, using the 20 points as landmarks to represent the patches. There was inter-surgeon variability in the level of patch suture lines, and the variability was higher in particular locations. There was inter-surgeon variability in the shape and size of patches, which was not affected by the exposures. The inter-surgeon variability in the shape of patches was higher in particular locations. There was intra-surgeon variability in the shape of patches. Inter-/intra-surgeon variability was analyzed and visualized by the surgical simulation using geometric morphometrics approaches. Further studies are needed to scrutinize whether the variability affects postoperative hemodynamics in actual surgery.

Hemostatic Proximal Anastomosis for Type A Acute Aortic Dissection: Reversed Turn-Up Technique (Akita Method).

In surgery for acute type A aortic dissection, controlling bleeding from the posterior wall of the proximal anastomosis is particularly challenging. To address this, we use the "reversed turn-up technique." For the reinforcement of the proximal aortic stump, Teflon felt strips were placed inside and outside the suture line with 4-0 polypropylene continuous transverse mattress sutures, and BioGlue was applied to the false lumen. For the posterior wall, circumferential interrupted sutures using 3-0 polypropylene with pledgets were placed, passing the needle from the inside to the outside of the aorta and from the outside to the inside of the graft, resulting in an "inward" turn-up of the posterior wall. Continuous sutures were added for further reinforcement. For the anterior wall, circumferential interrupted sutures using 3-0 polypropylene with pledgets were placed, passing the needle from the outside to the inside of the aorta and from the inside to the outside of the graft, achieving an outward turn-up. This technique provides reliable hemostasis, particularly for the posterior wall. From August 2016 to January 2024, we performed initial and isolated ascending aortic replacement for acute type A aortic dissection in 73 patients using the reversed turn-up technique. The postoperative 30-day mortality rate was 4.1%, and no patients required re-exploration for bleeding.