From ep 165 on our Surgery Stream. With Dr Tania Banks.
What’s the trickiest bit of GI tract to suture when you’re doing an end-to-end anastomosis? It’s the mesenteric side, right? All that fat obscures your view, so you can’t be quite as accurate with your suture placement. The data backs this up, with most post-op leakage happening in this area. In this episode on pro tips for doing a subtotal colectomy Dr Tania described her technique for suturing the colon (where perfect suture placement REALLY matters), but it’s a great trick for the rest of the GI tract too:
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Start your sutures at the mesenteric side, placing a series of interrupted sutures.
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Take full thickness bites from the serosal side, into the lumen and back out again, but visualise and confirm placement from the luminal side. I.e., you’re checking your work from inside the bowel where you can see much better.
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Once you’re happy that you’ve closed this area neatly you can start zipping up the sides, where you can see much better, from the outside.
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