Surgical sutures: coincidence or experience?

• Published in: Hernia : the journal of hernias and abdominal wall surgery 2017-08, Vol.21 (4), p.505-508
• Main Authors: von Trotha, K.-T., Grommes, J., Butz, N., Lambertz, A., Klink, C. D., Neumann, U. P., Jacobs, M., Binnebösel, M.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Abdominal Wound Closure Techniques; Clinical Competence; Humans; Laparotomy; Medicine; Medicine & Public Health; Original Article; Reproducibility of Results; Surgery; Suture Techniques; Sutures
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-017-1597-8

Background Knotting sutures by hand is still important in daily surgical routine, especially laparotomy closure. The expectation is that hand suturing relies on the experience and subjective estimation of the surgeon. The aim of this study was to investigate whether hand suturing tension is reproducible and if surgical experience influences reproducibility. Methods At the annual Congress of the German Association of Surgery, 118 surgeons performed repetitive sutures on a standardized and certified measuring device simulating the final knot of a fascial closure. Each surgeon was asked to perform five identical single knots in a row using the suture tension that each considered ideal. Tension during knotting was measured in Newtons. The surgeons were divided into five subgroups based on surgical experience: group 1, 30 years. Results The tension measured at the end of knotting ranged from 0.19 to 10 N. The mean suture tension at endpoint was 3.88 N for group 1 and slightly higher in the other groups, but not significantly different. The overall mean suture tension was 5.43 N and did not correlate with surgical experience. Suture tension was not reproducible. Conclusion Sequential suture tension varied, even among experienced surgeons. The ideal tissue-dependent suture tension has not been defined. Measured values appear to be intuitive, relying on individual feeling rather than the level of experience.