Best Suture Material for Omental Patch Repair
For omental patch repair, monofilament absorbable sutures are recommended as they cause less bacterial seeding and may be less likely to cause infection compared to multifilament options. 1
Optimal Suture Selection
- Monofilament synthetic sutures such as poliglecaprone (MONOCRYL) and polyglyconate (Maxon) are preferred for omental patch repair due to their reduced bacterial seeding properties 1
- Standard synthetic multifilament sutures like polyglycolic acid (Dexon) and polyglactin 910 (VICRYL) are acceptable alternatives but may have higher infection risk due to bacterial seeding in the interstices of the braid structure 1, 2
- Catgut should be avoided as it is associated with more pain and higher risk of requiring resuturing compared to synthetic options 1
Specific Considerations for Omental Patch Repair
- For perforated peptic ulcers smaller than 2 cm, primary repair with monofilament suture is recommended 1
- For perforated marginal ulcers or gastric/duodenal perforations less than 1 cm, primary suture with omental patch in laparoscopic approach is strongly recommended in stable patients 1
- The omental patch technique is particularly valuable in cases of large ulcers with friable edges to reduce the risk of sutures cutting through the edges 1
Evidence on Omental Patch Technique
- Multiple retrospective studies show low postoperative leak rates with the omental patch technique, even for perforations up to 2 cm in diameter 1
- However, several studies indicate that simple closure without an omental patch may have comparable results regarding leakage rates while requiring less operative time 1
- A multicenter non-randomized retrospective study of 297 patients found no significant association between the type of repair (with or without omental patch) and complication rates 1
Technical Considerations
- When using the omental patch technique, ensure the suture material has adequate strength to hold the omental patch in place without cutting through tissue 1
- Continuous non-locking suturing techniques are preferred as they distribute tension more evenly across the suture line 1
- For high-mobility areas or tissues under tension, stronger suture materials with longer absorption profiles are preferred 3
Common Pitfalls and Caveats
- Avoid overly tight sutures that can strangulate tissue and impair healing, particularly important in vascular areas like the omental patch 3
- Consider the mobility and tension of the surgical area when selecting suture material strength and size 3
- While omental patch may not be necessary for all repairs, it remains valuable for selected cases with friable tissue edges or larger perforations 1
- Monitor for signs of infection, including increasing pain, redness, swelling, or discharge at the surgical site 4