What type of suture is recommended for stomach repair?

Triclosan-Coated Absorbable Sutures for Stomach Repair

For stomach repair, triclosan-coated absorbable sutures are recommended to reduce the risk of surgical site infections while maintaining appropriate wound closure strength. 1

Optimal Suture Selection for Stomach Repair

Suture Material

• Primary recommendation: Triclosan-coated absorbable sutures (such as coated Vicryl Plus)

  • Significantly reduces surgical site infection (SSI) risk compared to non-coated sutures (RR 0.67,95% CI 0.48–0.94, P = 0.02) 1
  • Particularly effective in abdominal surgeries (RR 0.70,95% CI 0.50–0.99, P = 0.04) 1

• Suture type considerations:

  • Absorbable sutures are appropriate for stomach repair as they provide adequate tensile strength during the critical healing period
  • Polyglactin 910 (Vicryl) has demonstrated high tensile strength comparable to non-absorbable materials with good absorption profile 2
  • Monofilament vs. multifilament: Both are acceptable, with monofilament offering less tissue drag and potentially lower infection risk through elimination of interstices 3, 4

Suturing Technique

• Continuous vs. interrupted: No significant difference in SSI incidence between continuous and interrupted suturing techniques 1
• Subcuticular continuous suture demonstrates lower superficial wound dehiscence compared to interrupted stitches (RR 0.08; 95% CI 0.02 to 0.35) 1

Layered Approach to Stomach Repair

1. Mucosal layer: Fine absorbable suture (4-0 or 5-0)

   • Ensures watertight closure of the gastric mucosa

2. Submucosal and muscular layers: Triclosan-coated absorbable suture (3-0 or 4-0)

   • Provides primary strength for the repair
   • Antimicrobial properties reduce infection risk

3. Serosal layer: Triclosan-coated absorbable suture (3-0 or 4-0)

   • Reinforces repair and provides additional leak protection
   • Continuous or interrupted technique based on surgeon preference

Special Considerations

Contamination Level

• For clean or clean-contaminated surgical fields (CDC wound class I or II):

  • Synthetic absorbable sutures with triclosan coating are recommended 1

• For contaminated or dirty surgical fields (CDC wound class III or IV):

  • Consider biological mesh for large defects (>3cm) 1
  • For smaller defects, primary repair with triclosan-coated sutures is appropriate

Clinical Pitfalls to Avoid

1. Avoid excessive tension on suture lines which can lead to tissue ischemia and breakdown
2. Avoid using non-coated sutures in high-risk contaminated cases, as triclosan coating provides significant infection reduction benefit 1
3. Avoid PDS sutures for stomach repair as evidence shows no significant benefit of triclosan coating with this specific material 1

By following these recommendations with triclosan-coated absorbable sutures, surgeons can achieve optimal outcomes in stomach repair with reduced risk of surgical site infections and wound complications.