Intestinal suture

Intestinal suture is the term that unites suturing of wounds and defects of the abdominal part of the esophagus, stomach, intestines.

Ⅰ – Internal sheath; Ⅱ – External sheath.
Layers: 1 – mucosa; 2 – Submucosa; 3 – Muscularis; 4 – Serosa.
STRUCTURE OF INTESTINAL WALL
Serosa
Muscularis
Mucosa
Submucosa

Features of intestinal layers:
Serosa – layers can stick together in 12-14 hours and grow together in 1-2 days. This layer ensures containment of the intestinal suture (the suture pitch is not more than 2.5 mm);
Muscular – smooth muscles provide elasticity to the suture line.
Submucosa – its connection ensures mechanical toughness and good vascularization of suture.
Mucosa – connection of the edges of the wound provides good hemostasis.

Requirements for intestinal suture:
Containment;
Hemostasis without serious interruption of blood circulation of the suture line;
According to layers structure;
Toughness;
Primary intention is most likely;
Minimal trauma of organ’s walls;
Prevention of extensive marginal necrosis of the organ’s walls;
Rightful layers connection;
Considering for the possibility of eruption of seams;
Using absorbable suture materials.

TYPES OF INTESTINAL SUTURES

Le classification:
III. By overlay method:
Manual;
Mechanical.
I. By its location according to margins of the wound:
Marginal;
One-sheath sutures (serous-muscular or mucous-submucous);
Two-sheath sutures (through-and-through);
Non-marginal;
Combined.
II. By its location according to wound edges:
Inverting;
Everting.
V. By number of row:
One row;
Double row;
Triple row.
IV. By piercing through intestinal layers:
Aseptic;
Non-aseptic.

1. Serous-muscular, unpenetrated, invaginate, aseptic (or “2-nd row”) Lambert suture
Can be used only in combination with other sutures!
Non-marginal suture;
No hemostatic effect;
No toughness after applying;
Provides no adaptation to mucous and submucous layers.

2. Marginal serous-muscular sutures.
Mateshuk suture
Bier suture
+ Toughness, good adaptation, according to layers structure;
+ Prevents wall corrugation;
+ Prevents organ’s stenosis.
- Can be infected easily;
- High capillary effect (because of knot);
- High chances to healing with secondary intension (granulation).
ОДНОЗНАЧНО НЕ ТВОЙ БРО.
+ the same advantages as Mateshuk suture;
- Bad hemostatic effect;
- Bad adaptation of layers;
- Complexity.

Double row combined Czerny separate suture
+ Toughness, good adaptation, according to layers structure;
+ Prevents wall corrugation;
+ Prevents organ’s stenosis.
- Poor hemostatic effect;
- Difficulty of ensuring full adaptation of layers;
- Complexity.

3. Serous-muscular-submucous marginal sutures
Pirogov suture
Kirpatovsky suture
+ Great toughness, good adaptation;
+ very good hemostatic effect;
+ No rigidity and infection on a suture line;
+ Fast wound healing with primary tension.
- Adhesions are possible;
- Infection in other layers is possible in case of thread wicking effect;
- Tissue reaction is possible;
- frequent anastomosis failure (1-19%).
+ the same advantages as Pirogov suture.
- Skin corrugation and stenosis;
High rigidity of a suture line;
Wicking effect is possible (depends on suture material);
Big postoperative scar.

4. Double row combined sutures
Albert suture
Taupe suture
+ Toughness, good adaptation, according to layers structure, good hemostasis;
+ containment, aseptic;
+ Simplicity of applying.
- Inflammation on a suture line is possible;
- Slow tissue regeneration, massive skin corrugation;
- Secondary intension, necrosis can happen;
- Prolapse of mucous membrane;
- Adhesions are possible.
- More complex version of Albert suture.

Double row combined inverting Schmiden suture
+ Has all the advantages of Albert suture;
+ Speed of applying.
- Bad layers adaptation of intestinal wall because of tissue corrugation.

5. Triple row sutures
Versions:
Marginal through-and-through suture + serous-muscular marginal suture + serous muscular non-marginal suture;
Marginal mucous suture + serous-muscular marginal suture + serous muscular non-marginal suture;
Intestinal stump suturing by triple row suture.
1 – Continuous wrapping through-and-through suture;
2 – planar simple purse string serous-muscular suture;
3 – Z-shaped planar purse string serous-muscular suture.
1
2
3

ANTERIOR ABDOMINAL
WALL

Layers of anterior abdominal wall:
Skin;
Fatty tissue;
Proper fascia of external oblique muscles;
External oblique muscles;
Internal oblique muscles + its fascia;
Transversal abdominal muscles + its fascia;
Transversal fascia;
Parietal peritoneum.