Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 1039-1049
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1039
Novel suturing technique, based on physical principles, achieves a breaking point double that obtained by conventional techniques
Francisco Javier Pérez Lara, Rogelio Zubizarreta Jimenez, Francisco Javier Moya Donoso, Jose Manuel Hernández Gonzalez, Tatiana Prieto-Puga Arjona, Ricardo Marín Moya, Maria Pitarch Martinez
Francisco Javier Pérez Lara, Francisco Javier Moya Donoso, Jose Manuel Hernández Gonzalez, Tatiana Prieto-Puga Arjona, Ricardo Marín Moya, Maria Pitarch Martinez, Department of Surgery, Hopital de Antequera, Malaga 29200, Spain
Rogelio Zubizarreta Jimenez, DOXA, Malaga 29730, Spain
Author contributions: Pérez Lara FJ made a substantial contribution to the concept and design, drafted the article or revised it critically for important intellectual content, and approved the version to be published; Zubizarreta Jimenez R drafted the article or revised it critically for important intellectual content and approved the version to be published; Moya Donoso F approved the version to be published; Hernández González JM approved the version to be published; Prieto-Puga T approved the version to be published; Marín Moya R approved the version to be published; Pitarch Martínez M approved the version to be published.
Institutional review board statement: This study didn't involve the human subjects.
Conflict-of-interest statement: The authors have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francisco Javier Pérez Lara, PhD, Doctor, Department of Surgery, Hopital de Antequera, Avda. Poeta Muñoz Rojas sn, Antequera 29200, Malaga, Spain. javinewyork@hotmail.com
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: May 4, 2021
Revised: May 10, 2021
Accepted: August 4, 2021
Article in press: August 4, 2021
Published online: September 27, 2021
Processing time: 231 Days and 17.1 Hours
Abstract
BACKGROUND

Sutures have been used to repair wounds since ancient times. However, the basic suture technique has not significantly changed. In Phase I of our project, we proposed a “double diabolo” suture design, using a theoretical physical study to show that this suture receives 50% less tension than conventional sutures, and so a correspondingly greater force must be applied to break it.

AIM

To determine whether these theoretical levels of resistance were met by the new type of suture.

METHODS

An observational study was performed to compare three types of sutures, using a device that exerted force on the suture until the breaking point was reached. The tension produced by this traction was measured. The following variables were considered: Tearing stress on entry/exit points, edge separation stress, and suture break stress. The study sample consisted of 30 sutures with simple interrupted stitches (Group 1), 30 with continuous stitches (Group 2), and 30 with the “double diabolo” design (Group 3).

RESULTS

The mean degree of force required to reach the breaking point for each of these variables (tearing, separation, and final breaking) was highest in Group 3 (14.56, 18.28, and 21.39 kg), followed by Group 1 (7.36, 10.38, and 12.81 kg) and Group 2 (5.77, 7.7, and 8.71 kg). These differences were statistically significant (P < 0.001) in all cases.

CONCLUSION

The experimental results show that with the “double diabolo” suture, compared with conventional sutures, greater force must be applied to reach the breaking point (almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture). If these results are confirmed in Phase III (the clinical phase) of our study, we believe the double diabolo technique should be adopted as the standard approach, especially when the suture must withstand significant tension (e.g., laparotomy closure, thoracotomy closure, diaphragm suture, or hernial orifice closure).

Keywords: Suture; Technique; Physical principles; Tension

Core Tip: The aim of this project was to design and validate a new technique that imposes the least possible tension on the suture threads and entry/exit points, thus creating a suture that is more stable and resistant. We manufactured a device to apply a progressively increasing separation force to the suture surfaces, and to measure the tension exerted until the breaking point is reached. With this device we compared three groups: Simple interrupted stitches, continuous stitches, and our proposed technique.