Asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis: A preliminary study

Abstract

Background: Anastomotic leakage is a life-threatening complication. Improvement of the anastomosis technique is needed, especially in patients with an inflamed edematous intestine. The aim of our study was to evaluate the safety and efficacy of an asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis in pediatric patients.

Methods: A total of 23 patients underwent intestinal anastomosis at the Department of Pediatric Surgery of Binzhou Medical University Hospital. Demographic characteristics, laboratory parameters, anastomosis time, duration of nasogastric tube placement, day of first postoperative bowel movement, complications, and length of hospital stay were statistically analyzed. The follow-up was conducted for 3-6 months after discharge.

Results: Patients were divided into two groups: the single-layer asymmetric figure-of-eight suture technique (group 1) and the traditional suture technique (group 2). Body mass index in group 1 was lower than in group 2 (14.43 ± 3.23 vs. 19.38 ± 6.74; P = 0.036). The mean intestine anastomosis time in group 1 (18.83 ± 0.83 min) was less than that in group 2 (22.70 ± 4.11 min; P = 0.005). Patients in group 1 had an earlier first postoperative bowel movement (2.17 ± 0.72 vs. 2.80 ± 0.42; P = 0.023). The duration of nasogastric tube placement in group 1 was shorter than that in group 2 (4.12 ± 1.42 vs. 5.60 ± 1.57; P = 0.043). There was no significant difference in laboratory variables, complication occurrence, and length of hospital stay between the two groups.

Conclusion: The asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis was feasible and effective. More studies are needed to compare the novel technique with the traditional single-layer suture.

Keywords: asymmetric figure-of-eight suture; intestinal anastomosis; pediatric; postoperatively complications; single layer suture.

Figure 1

A schematic representation of the asymmetric figure-of-eight suture. The technique has been described in detail previously (17).

Figure 2

A 5-month-old boy with generalized peritonitis and septic shock caused by a perforated terminal ileum due to a congenital fibrotic band compression. (A) Perforation (small Δ) and necrosis (arrow) at the terminal ileum; (B) completion of primary anastomosis (large Δ) using the asymmetric figure-of-eight suture technique.

Figure 3

Comparison of the asymmetric figure-of-eight suture technique and traditional single-layer suture technique. (A) A 50-day-old boy with biliary atresia undergoing Kasai portoenterostomy, completion of end-to-side jejuno-jejunal anastomosis (△); (B) a six-year-old boy with Meckel's diverticulum complicated by strangulated internal hernia undergoing necrotic bowel resection and end-to-end ileoileal anastomosis (※).