Simple Continuous Versus Cushing Suture for Jejunal end-to-end Anastomosis in the Dogs: a Comparative Study

Abstract

For the anastomosis of canine jejunum, single-layer appositional closures are preferred to inverting or everting patterns, whereas inverted or everted closures require second-intention healing and increase the risk of luminal stenosis or anastomosis site leakage. Nevertheless, following simple continuous sutures, the dehiscence rates remain high. Our objectives were to compare the appositional simple continuous sutures with the inverting Cushing sutures, investigating: suture resistance, bursting pressure, lumen diameters on canine cadavers, as well as survival and complication rates in canine clinical cases. Our ex vivo experimental results indicate that: the efforts to which sutures are submitted to in anastomoses are minimal for the Cushing suture, the differences between the bursting pressure measured for the two types of sutures indicate the superiority of the Cushing suture, the difference in size of the anastomoses’ lumen between the two sutures are minimal. The retrospective analysis of intestinal end-to-end anastomoses (123 - simple continuous sutures and 388 - Cushing sutures) revealed 7 anastomotic complications, all following simple continuous anastomoses. Our results reveal the superiority of the Cushing suture, compared to simple continuous suture, which emphasizes the fact that the Cushing suture should be considered a good option when performing end-to-end jejunal anastomoses in canine patient.