Skip to main content
SpringerLink
Log in

Surgical sutures: coincidence or experience?

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

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, <1 year; group 2, 2–5 years; group 3, 6–10 years; group 4, 11–20 years; and group 5, >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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Israelsson LA, Jonsson T (1993) Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 80(10):1284–1286

    Article  CAS  PubMed  Google Scholar 

  2. Myers MB, Cherry G (1970) Functional and angiographic vasculature in healing wounds. Am Surg 36(12):750–756

    CAS  PubMed  Google Scholar 

  3. Bartlett LC (1985) Pressure necrosis is the primary cause of wound dehiscence. Can J Surg 28(1):27–30

    CAS  PubMed  Google Scholar 

  4. Fielding LP, Stewart-Brown S, Blesovsky L, Kearney G (1980) Anastomotic integrity after operations for large-bowel cancer: a multicentre study. Br Med J 281(6237):411–414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Sugerman HJ, Kellum JM Jr, Reines HD, DeMaria EJ, Newsome HH, Lowry JW (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171(1):80–84. doi:10.1016/S0002-9610(99)80078-6

    Article  CAS  PubMed  Google Scholar 

  6. Fischer L, Bruckner T, Muller-Stich BP, Hoer J, Knaebel HP, Buchler MW, Seiler CM (2010) Variability of surgical knot tying techniques: do we need to standardize? Langenbeck’s Arch Surg [Deutsche Gesellschaft fur Chirurgie] 395(4):445–450. doi:10.1007/s00423-009-0575-8

    Article  Google Scholar 

  7. Stumpf M, Klinge U, Mertens PR (2004) Anastomotic leakage in the gastrointestinal tract-repair and prognosis. Der Chir Z Geb Oper Med 75(11):1056–1062. doi:10.1007/s00104-004-0956-z

    CAS  Google Scholar 

  8. Jansen PL, Mertens Pr P, Klinge U, Schumpelick V (2004) The biology of hernia formation. Surgery 136(1):1–4. doi:10.1016/j.surg.2004.01.004

    Article  PubMed  Google Scholar 

  9. Zheng H, Si Z, Kasperk R, Bhardwaj RS, Schumpelick V, Klinge U, Klosterhalfen B (2002) Recurrent inguinal hernia: disease of the collagen matrix? World J Surg 26(4):401–408. doi:10.1007/s00268-001-0239-5

    Article  PubMed  Google Scholar 

  10. Junge K, Klinge U, Rosch R, Mertens PR, Kirch J, Klosterhalfen B, Lynen P, Schumpelick V (2004) Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbeck’s Arch Surg [Deutsche Gesellschaft fur Chirurgie] 389(1):17–22. doi:10.1007/s00423-003-0429-8

    Article  Google Scholar 

  11. Bellon JM, Bajo A, Ga-Honduvilla N, Gimeno MJ, Pascual G, Guerrero A, Bujan J (2001) Fibroblasts from the transversalis fascia of young patients with direct inguinal hernias show constitutive MMP-2 overexpression. Ann Surg 233(2):287–291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hoer J, Wetter O, Peschke C, Schumpelick V, Weck M (2001) Einsatz miniaturisierter Sensoren zur Kontrolle von Naht- und Fadenspannung in der Chirurgie. In: Neue Technologien für die Medizin.. Neue Technologien für die Medizin, Forschung, Praxis, Innovation 3 Symposium 10/11 Mai 2001. Aachen, Shaker

  13. Klink CD, Binnebosel M, Alizai HP, Lambertz A, von Trotha KT, Junker E, Disselhorst-Klug C, Neumann UP, Klinge U (2011) Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model. BMC Surg 11:36. doi:10.1186/1471-2482-11-36

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tera H, Aberg C (1976) Tissue strength of structures involved in musculo-aponeurotic layer sutures in laparotomy incisions. Acta Chir Scand 142(5):349–355

    CAS  PubMed  Google Scholar 

  15. Stone IK, von Fraunhofer JA, Masterson BJ (1986) The biomechanical effects of tight suture closure upon fascia. Surg Gynecol Obstet 163(5):448–452

    CAS  PubMed  Google Scholar 

  16. Schachtrupp A, Wetter O, Hoer J (2015) An implantable sensor device measuring suture tension dynamics: results of developmental and experimental work. Hernia: the journal of hernias and abdominal wall surgery. doi:10.1007/s10029-015-1433-y

    Google Scholar 

Download references

Acknowledgement

This work was supported by Ethicon, Johnson & Johnson, Norderstedt, Germany.

Authors’ contributions

KTvT, JG and MB contributed to the study conception and design. KTvT, NB, AL and CDK contributed to the acquisition of data. KTvT, JG, NB, AL, CDK, UPN, MJ and MB contributed to the analysis and interpretation of data. KTvT, JG, NB, AL, CDK, UPN, MJ and MB contributed to the drafting of manuscript. KTvT, JG, NB, AL, CDK, UPN, MJ and MB contributed to the critical revision of manuscript.

Author information

Authors and Affiliations

  1. Department of Vascular and Endovascular Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    K.-T. von Trotha, J. Grommes & M. Jacobs

  2. Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Aachen, Germany

    A. Lambertz, C. D. Klink, U. P. Neumann & M. Binnebösel

  3. Department of General and Visceral Surgery, Antonius Hospital Eschweiler, Eschweiler, Germany

    N. Butz

Authors
  1. K.-T. von Trotha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Grommes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Butz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Lambertz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. D. Klink
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. U. P. Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Binnebösel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K.-T. von Trotha.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Funding

The measuring device as well as the sutures were provided by Ethicon, Johnson & Johnson, Norderstedt, Germany, no further funding was received.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

von Trotha, KT., Grommes, J., Butz, N. et al. Surgical sutures: coincidence or experience?. Hernia 21, 505–508 (2017). https://doi.org/10.1007/s10029-017-1597-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-017-1597-8

Keywords

Search

Navigation