A controlled trial of inverting versus everting intestinal suture in clinical large-bowel surgery

Abstract

Abstract A controlled evaluation of a single-layer everting technique of suture versus a conventional two-layer inverting technique has been attempted in clinical large-bowel surgery. Thirty-five patients suffering from carcinoma or other diseases of the large intestine were allocated randomly to each technique in the conduct of various forms of colonic resection with anastomosis or closure of a transverse colostomy. There were 3 operative deaths after everting suture and 1 after inverting suture, all attributable mainly to anastomotic failure. A higher proportion of patients developed wound infection or peritonitis after everting than inverting suture—51 as against 35 per cent. Overt faecal fistulation was observed in no less than 43 per cent of the patients having everting suture, but in only 8·6 per cent of those treated by inverting suture. Late stricture formation was noted in 2 cases after everting suture, but in none after inverting suture. These experiences are considered to provide a clear condemnation of the use of an everting technique of suture in the large intestine in clinical practice.