Choice of suture technique
Objective 2. Appreciate the optimal use of sutures in ileocolic anastomoses
Choosing an interrupted or continuous technique:
No prospective randomised trials have compared interrupted versus continuous techniques for handsewn ileocolic anastomoses.
Surgeons agreed that either technique is acceptable in healthy tissue.
However, interrupted sutures may be preferable in diseased or oedematous tissue, where the security of each suture bite might be uncertain.
As the tissue oedema decreases postoperatively, there is a risk that a continuous suture may loosen.
- In a rabbit model, both interrupted and continuous techniques decreased colonic anastomotic tissue oxygen tension.
- However, mean tissue oxygen tension in the continuous group was significantly lower than in the interrupted group (P < 0.01).
- The leakage rate was 10 % for anastomoses constructed with a perianastomotic tissue oxygen tension > 55 mmHg compared with 100 % < 25 mmHg (P <0.001).
Related paper: Colonic anastomotic healing and oxygen tension
This video shows surgeons discussing their practice for handsewn ileocolic anastomoses:
Choice of single layer or double layer closure:
Several prospective randomised trials exist exploring the use of single versus double layer intestinal anastomosis and the risk of anastomotic leak.
These are summarised within a Cochrane meta-analysis.
No difference was detected in the rate of anastomotic leak between single and double layer interrupted anastomoses.
Evidence demonstrates that single-layer closure when applied with the correct technical training is sufficient for ileocolic anastomoses.
Related paper: Single-Layer Continuous Versus Two-Layer Interrupted Intestinal Anastomosis
A summary of the Cochrane meta-analysis and its findings can be found below:
This summary video demonstrates variations in techniques for handsewn anastomosis and a discussion of best evidence: