Suture material for enterotomy

Re: Suture material for enterotomy

Gillian Mostyn — Thu, 24 Mar 2011 15:39:37 GMT

Took a peach stone out of a small intestine this morning - this thread made me really consider what suture I chose!!!

Re: Suture material for enterotomy

Evelyn Barbour-Hill — Thu, 24 Mar 2011 15:17:21 GMT

[quote user="Laurence Webb"]The surprising answer was that just 3 simple interrupted sutures sealed the guts and few needed further surgery at a later date. Makes you wonder how much time we waste getting everything nicely approximated![/quote]

Not sure I'd like to chance it but the gut does heal very rapidly. Also there is a wonderful mechanism called the omentum which comes along all by itself and wraps up the repair.

Re: Suture material for enterotomy

Laurence Webb — Thu, 24 Mar 2011 13:17:31 GMT

I used to use Monocryl and got on well with it. I've used Vicryl but don't like the drag that a multifilament causes (although it is obvious that many other people use it successfully). PDS has a lot of memory so doesn't knot as well as either and is quite spikey.

When I attempted to rationalise the different types of suture material we stocked I found Biosyn a good all rounder. It isn't quite as soft as monocryl but much nicer to handle and knot than PDS. It lasts longer than Monocryl too. it comes with nice reverse cutting needles which are great for intestinal surgery.

Frankly I'd use whatever you feel most comfortable with.

As an aside, I recall that a lot of the investigation into gut healing was done by the US Army during the Vietnam war. In order to treat the highest number of troopis in the shortest amount of time they needed to know how few sutures they could get away with in a field hospital before shipping troops somewhere for more definative surgery. I believe the work was done in dogs.

The surprising answer was that just 3 simple interrupted sutures sealed the guts and few needed further surgery at a later date. Makes you wonder how much time we waste getting everything nicely approximated!

Re: Suture material for enterotomy

Gerry Henry — Thu, 24 Mar 2011 12:25:37 GMT

Swaged Monocryl every time; 1.5 METRIC (sorry for capitals but important not to confuse with the nought scale) for small puppies/cats, 2 METRIC for larger animals; also v good for cystotomies. Caesars 2 or 3 Metric depending on size.

Re tying, you'll get the knack of tightening monofilament without crushing the tissue if you practice; gently with the first throw, gradually > pressure with the 2nd and 3rd (I do a 4th and tension it quite hard); also lift the knot very slightly as you tension, iot helps with a nice anatomical reconstruction.

Re: Suture material for enterotomy

Evelyn Barbour-Hill — Thu, 24 Mar 2011 11:22:32 GMT

[quote user="Dagmar Steele"]the obvious downsides[/quote]

More theoretical than real, it seems.

Re: Suture material for enterotomy

Dagmar Steele — Thu, 24 Mar 2011 11:20:50 GMT

I use Vicryl, too. I don't really like PDS, seems I am too silly to use it, had some bleeders with it, so prefer Vicryl despite the obvious downsides.

Re: Suture material for enterotomy

stephen sargent — Thu, 24 Mar 2011 11:13:20 GMT

[quote user="Michael Woodhouse"]I use Vicryl for suturing intestines.[/quote]

Me too!

Re: Suture material for enterotomy

Evelyn Barbour-Hill — Thu, 24 Mar 2011 11:09:22 GMT

4/0 Vicryl is excellent for the purpose. Occasionally 5/0 for tiny guts. 3/0 is too thick.

Re: Suture material for enterotomy

Anonymous — Thu, 24 Mar 2011 09:07:48 GMT

I use 4/0 monocryl for small intestinal biopsy sites but for anything that is inflamed or colon then I would use 4/0 pds. I think multi filament is a bit risky because of the wicking effect but it shouldn't be in the lumen anyway but could still be a risk. I find the larger material (3/0) more difficult to tie and place in the gut and have found the smaller 4/0 much easier to work with.

Re: Suture material for enterotomy

Alan Tevendale — Thu, 24 Mar 2011 07:32:25 GMT

Personally I like PDS for guts. Tend to go for as fine a material as I think is appropriate for the individual patient but generally not larger than 3-0. Agree with people saying that familiarity with a particular material is very important.

Re: Suture material for enterotomy

Rob Loxley — Wed, 23 Mar 2011 23:57:11 GMT

Can't see the reason not to use vicryl, since you're not going full thickness so wicking really shouldn't be an issue.

3/0 sounds pretty fat (I'd be using that for the linea alba in small patients!), I'd maybe go for 4/0 or 5/0 in PDS. Equally monocyl should be lasting plenty long enough unless your intestine is really unhealthy, at which point doing a bit more resection to healthy tissue should be a consideration.

At the end of the day and at some point, success (and a good night's sleep) probably comes down as much to familiarity with the material rather than exact choice per se. Hence the people using chromic gut successfully.

Re: Suture material for enterotomy

Michael Woodhouse — Wed, 23 Mar 2011 22:53:34 GMT

I hate threads like this where as you read along you get an awful sinking feeling that you've been doing something wrong all this time.

I use Vicryl for suturing intestines. Did an end to end anastomosis last month that has done very well. Just did a quick search to put my mind at rest

http://www.ncbi.nlm.nih.gov/pubmed/3902412

Use some very fine 1.5metric - same stuff we use for eye lid surgery.

Re: Suture material for enterotomy

Mark Holmes — Wed, 23 Mar 2011 22:39:19 GMT

Can I be honest, just use pds more frequently, I use it all the time for (just about) everything and positively love the stuff. Initially was a bit awkward but like anything familiarity helps. (it also breeds contempt but ignoring that) Usually 1.5m or 2m. You get used to the memory pretty quickly and it's a blessing not having the drag you get with multifilament stuff. Not that you would use multifilament in gut.

Re: Suture material for enterotomy

Louise6732 — Wed, 23 Mar 2011 22:13:40 GMT

Yes the tiny one, I used it on a cocker spaniel pup 12w old and also an adult springer spaniel. Size seemed appropriate when suturing!

Much less springy, I find PDS difficult to use but don't use it often, I use Monocryl when suturing gingival flaps on surgical tooth extractions, so I'm a bit more used to working with it!

Louise

Re: Suture material for enterotomy

Sara Ramsey — Wed, 23 Mar 2011 21:43:32 GMT

[quote user="Louise Alexander"]

I've only done two, and used 5-0 Monocryl (Ethicon). Not as hard to handle because it was so fine.

(Sorry if I've got the suture size the complete wrong way round, long day! I mean the thinnest one, think is 5-0!)

Louise

[/quote]

is monocryl less "springy" than PDS? also 5-0 sounds tiny! this was a Dobermann but I wonder if using a much finer suture material would be easier.

Re: Suture material for enterotomy

Louise6732 — Wed, 23 Mar 2011 21:37:58 GMT

I've only done two, and used 5-0 Monocryl (Ethicon). Not as hard to handle because it was so fine.

(Sorry if I've got the suture size the complete wrong way round, long day! I mean the thinnest one, think is 5-0!)

Louise

Re: Suture material for enterotomy

nikki — Wed, 23 Mar 2011 21:37:21 GMT

we all use monocryl at our practice. 3/0 or 4/0 depending on size of dog. always do single throw on the first knot to reduce amount of suture material in the knot.

Re: Suture material for enterotomy

Mark Hedberg — Wed, 23 Mar 2011 21:00:19 GMT

I don't think it's a silly question at all. Monofilament absorbing suture is certainly the right idea; unfortunately the easiest one to work with is the one that you're not really supposed to use anymore. (catgut, anyone?)

(Apologies if this is a silly answer, PDS *is* spikier than I like to use around soft guts!)