The experimental basis of intestinal suturing |
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Authors: | Dr Garth H Ballantyne MD |
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Institution: | (1) Department of Surgery, St. Luke's Hospital, 707 17th Street S.E., 55904 Cleveland, Ohio;(2) 707 17th Street S.E., 55904 Rochester, Minnesota |
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Abstract: | Factors that incite inflammation at the healing wound prolong the lag period of wound healing and delay the return of strength
at the suture line. Inflammation activates bowel-wall collagenase, which degrades the collagen within the wound, eroding the
foundation in which sutures are anchored. Experimental studies have compared the impact of various surgical techniques. Sutures
placed by hand uniformly invoke an inflammatory response because dragging the thread through the bowel wall injures tissue.
Single-layer anastomoses heal more rapidly than double-layer suture lines. The inner layer causes avascular necrosis of the
inverted cuff. Experimental studies have not clearly shown the superiority of inverting suture lines over everting ones. Experimental
studies done over the last century indicate that the single-layer inverting anastomosis recommended by Lembert and Halstead
adequately compensates for enteric wound weakness during the lag period. Other techniques of sewing an anastomosis provide
no clear advantage. Other factors that incite inflammation also delay enteric wound healing. Debris, necrotic tissue, or infection
illicit an inflammatory response with detrimental effects on the anastomosis. Antibiotics, by assisting in the control of
infection or by minimizing the size of an inoculum help speed healing. Stapling devices violate many of the doctrines of intestinal
suturing. Experimental studies suggest, however, that staple lines incite a minimal inflammatory response. Consequently, wounds
closed with stapling devices regain strength more rapidly than those closed with traditional surgical techniques. |
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Keywords: | Intestinal suturing Intestinal anastomoses Intestinal stapling Stapling devices Wound healing Surgical technique Suture materials |
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