Comparação de três diferentes suturas com fio absorvível farpado ou monofilamentar em enterorrafia em suínos
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Data
2019-04-17
Autores
Paiva, Bruna Ribeiro [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Devido à alta incidência de cirurgias gastrointestinais nas diferentes espécies, incluindo o homem, diversas técnicas e materiais são continuamente desenvolvidos visando otimizar os procedimentos e diminuir as principais complicações observadas, dentre elas deiscência, extravasamento de conteúdo, aderências, peritonite e sepse. O fio farpado é uma recente opção de sutura, que beneficia especialmente as modalidades cirúrgicas laparoscópicas ou videoassistidas, pois a dispensabilidade de nós facilita a sutura e diminui o tempo cirúrgico. Ainda, as farpas ao redor do fio permitem melhor adesão ao tecido e distribuição uniforme da tensão. Com o objetivo de comparar três tipos suturas realizadas com o fios absorvíveis monofilamentares, farpado ou liso, em relação ao tempo de sutura, escore de aderência, resistência ao teste de ruptura e avaliação histológica, foram executadas enterorrafias em jejuno de 12 suínos (sutura farpada, sutura contínua e isolada simples). Os animais foram randomizados em três grupos (n=4), referindo-se aos dias pós-operatórios para coleta das amostras (G3, G10 e G21). Houve diferença entre as médias dos tempos de execução, quando comparadas as suturas farpada (274,33±70,48) e contínua (350,41±87,25), em relação à isolada (469,00±109,72). Comparando-se os três padrões, nos diferentes momentos, os escores de aderência e as pressões aferidas no teste de ruptura não apresentaram diferença significativa, assim como a análise histopatológica, onde não foi observado diferença no grau de inflamação, fibrose, alinhamento tecidual, necrose e neovascularização. Não ocorreram complicações devido à falha das suturas. A sutura farpada apresentou resultado semelhante aos demais padrões testados, porém sendo superior com relação ao tempo de execução da sutura.
Due to the high incidence of gastrointestinal surgeries in many species including humans, several techniques and materials have been continuously investigated to improving the procedures towards to avoid the most common complications, including dehiscence, leakage of contents, adhesions, peritonitis and sepsis. Barbed suture has recently come under focus for laparoscopic or video-assisted procedures, once it is a knotless suture and makes the suturing time shorter. In addition, the barbs around the suture promotes better adhesion to the tissue and uniform distribution of the tension. To compare three types of sutures performed with monofilament conventional or barbed suture, both absorbable, in relation to suture time, adhesion score, burst pressure and histology, jejunal sutures were performed in 12 pigs (barbed suture, continuous suture and simple interrupted). The groups (n = 4) were randomized, referring to the postoperative days for final evaluation (G3, G10 and G21). There was a difference on suturing time, when compared barbed (274.33 ± 70.48) and continuous (350.41 ± 87.25) to the interrupted pattern (469.00 ± 109.72). Among the 3 techniques at G3, 10 or 21, adherence scores and bursting pressure were not significantly different as well as histology evaluation, since no difference could be detected, in the grade of inflammation, fibrosis, tissue alignment, necrosis and neovascularization, at the suturing sites. No complications due to suture failures were observed. Barbed suture was similar as compared to conventional patterns, but faster than them.
Due to the high incidence of gastrointestinal surgeries in many species including humans, several techniques and materials have been continuously investigated to improving the procedures towards to avoid the most common complications, including dehiscence, leakage of contents, adhesions, peritonitis and sepsis. Barbed suture has recently come under focus for laparoscopic or video-assisted procedures, once it is a knotless suture and makes the suturing time shorter. In addition, the barbs around the suture promotes better adhesion to the tissue and uniform distribution of the tension. To compare three types of sutures performed with monofilament conventional or barbed suture, both absorbable, in relation to suture time, adhesion score, burst pressure and histology, jejunal sutures were performed in 12 pigs (barbed suture, continuous suture and simple interrupted). The groups (n = 4) were randomized, referring to the postoperative days for final evaluation (G3, G10 and G21). There was a difference on suturing time, when compared barbed (274.33 ± 70.48) and continuous (350.41 ± 87.25) to the interrupted pattern (469.00 ± 109.72). Among the 3 techniques at G3, 10 or 21, adherence scores and bursting pressure were not significantly different as well as histology evaluation, since no difference could be detected, in the grade of inflammation, fibrosis, tissue alignment, necrosis and neovascularization, at the suturing sites. No complications due to suture failures were observed. Barbed suture was similar as compared to conventional patterns, but faster than them.
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Palavras-chave
fio farpado, intestino, aderência, pressão de ruptura, barbed suture, intestine, adhesion, burst pressure