Impact of Needle-to-Suture Ratio and Suture Diameter on Acute Leakage Pressure in an Ex Vivo Canine Jejunal Enterotomy Model.

Postoperative intestinal leakage is a serious complication of gastrointestinal surgery; however, the immediate mechanical factors affecting enterotomy sealing remain incompletely understood. This ex vivo study evaluated the association of needle-to-suture ratio (N:S Ratio) and suture diameter with acute leakage pressure in a canine jejunal enterotomy model. Eight needle-suture product groups were tested using 80 fresh jejunal segments obtained from 10 canine cadavers. A randomized complete block design was used, with each dog contributing one jejunal segment to each suture group. After standardized enterotomy closure, the initial leakage pressure (ILP), maximum intraluminal pressure (MIP), and initial leakage location were recorded. Linear mixed-effects models were used, with the suture group as a fixed effect and dog identity as a random intercept. Initial leakage occurred predominantly at the needle-hole site, accounting for 75 of the 80 samples (93.75%). The suture group had a significant overall effect on both log-transformed ILP and MIP. In predefined comparisons under more comparable needle-suture conditions, higher N:S Ratio were associated with lower acute leakage pressures. However, within the SHMP commercial suture series, leakage pressure did not follow a simple monotonic relationship with the N:S Ratio. Together, these findings indicate that needle-suture matching is relevant to acute sealing under more comparable product conditions, whereas the performance of commercial needle-suture products cannot be explained by N:S Ratio alone. These findings suggest that needle-hole sealing is a major component of acute leakage resistance after canine jejunal enterotomy closure. Further in vivo and clinical studies are required before specific recommendations regarding needle-suture selection can be made.