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study on pain levels/inguinal hernia absorbable sutures versus non absorbable

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  • study on pain levels/inguinal hernia absorbable sutures versus non absorbable

    As I'm trying to find out more about suture materials and how they react to the body I came across this study. https://www.journalacs.org/article/S...13)01078-8/pdf the non absorbable has higher recurrence rate which is why the surgeon I am speaking to doesn't want to use it. I don't see a distinction here between the prolene and the silk thread for non absorbable and I wonder if that makes any kind of difference in chronic pain. The surgeon I am speaking to did say that there is initially more redness and irritation with the absorbable sutures (and he mentioned the braid so that might hold true with the silk too). Thoughts? I think this is my final decision although it might require a different surgeon if absorbable.

  • #2
    My guess is you are talking about absorbable sutures versus non absorbable in no-mesh repairs?

    This is only my opinion. I am not a doctor or an expert.

    Shouldice hospital is the only one using non-absorbables sutures, and it seems they are the best in no-mesh inguinal repairs. The rates speak by themselves.
    I think there are multiple doctors around they claim to do shouldice technique, but they have modified they technique since they are not using non-absorbables sutures.

    Comment


    • #3
      I am fairly sure that the Shouldice Hospital actually uses stainless steel suture material for the actual Shouldice procedure. It's been a discussion topic. They might use absorbable suture material for closure of the entry point, but I think that everyone does that.

      These are good questions though, because "pure tissue" is often used to describe what are really sutured tissue repairs. It's not pure.

      https://onlinelibrary.wiley.com/doi/...X.2009.09155.x


      "SPECIFIC EQUIPMENT/MATERIALS

      Stainless steel wire 32–34 G is the suture material of choice, and originally chosen because it is inert and does not form a nidus of infection, should one occur. Initially the wire can be difficult to handle but this problem is soon overcome.
      "

      Comment


      • #4
        Yes. I am talking about no mesh repairs. Shouldice hospital may be the only people using the steel suture but I think the polymer suture is pretty standard there is also a silk suture that is non-absorbable. I don't know how that compares to the polymer or why a surgeon would choose to use it. It is my sense that the absorbable sutures are actually not used as frequently but I don't know.

        Comment


        • #5
          for what I read the method Desarda and Guarnieri use non-absorbable sutures, Shouldice uses two rows of non-absorbable sutures in depth and the other absorbable rows.
          however from these somewhat dated links (1996 and 2001) the Authors report research with follow-up that compare non-absorbable and absorbable materials in terms of side effects, https://www.ncbi.nlm.nih.gov/pubmed/8908956 e
          https://link.springer.com/chapter/10...4419-8574-3_30

          Comment


          • #6
            Dill
            The major purpose of sutures is to hold the tissues together until the body heals the tissues together.
            The final strength is dependent more on the body's healing than the sutures.
            At three weeks a wound has about 70% of the final strength.
            At six weeks a wound has about 90% of the final strength.
            It is not until about 12 weeks before there is 100% strength.
            Thus the ideal suture is one that keeps its strength for at least three months.
            I use silk sutures because it maintains excellent strength for six months and then slowly dissolves.
            Silk also allows the tension to be set at just the right amount.
            And silk has the smallest knots, meaning that less material is left inside.

            review:
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174176/


            Regards.
            Bill Brown MD

            Comment


            • #7
              Originally posted by DrBrown View Post
              Dill
              The major purpose of sutures is to hold the tissues together until the body heals the tissues together.
              The final strength is dependent more on the body's healing than the sutures.
              At three weeks a wound has about 70% of the final strength.
              At six weeks a wound has about 90% of the final strength.
              It is not until about 12 weeks before there is 100% strength.
              Thus the ideal suture is one that keeps its strength for at least three months.
              I use silk sutures because it maintains excellent strength for six months and then slowly dissolves.
              Silk also allows the tension to be set at just the right amount.
              And silk has the smallest knots, meaning that less material is left inside.

              review:
              https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174176/


              Regards.
              Bill Brown MD
              But what about complication with silk sutures, do they often get inflammation?

              Comment


              • #8
                columb.if
                Silk is a natural fiber. There is minimal foriegn body response by the body.
                Regards.
                Bill Brown MD

                Comment


                • #9
                  Originally posted by DrBrown View Post
                  Dill
                  The major purpose of sutures is to hold the tissues together until the body heals the tissues together.
                  The final strength is dependent more on the body's healing than the sutures.
                  At three weeks a wound has about 70% of the final strength.
                  At six weeks a wound has about 90% of the final strength.
                  It is not until about 12 weeks before there is 100% strength.
                  Thus the ideal suture is one that keeps its strength for at least three months.
                  I use silk sutures because it maintains excellent strength for six months and then slowly dissolves.
                  Silk also allows the tension to be set at just the right amount.
                  And silk has the smallest knots, meaning that less material is left inside.

                  review:
                  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174176/


                  Regards.
                  Bill Brown MD
                  if still in line I would ask if this suture is ideal only to close the wound of the operation or even to join the band with muscle. because in the latter case, then, in theory, those who write that some absorbables have the same non-absorbable index of recurrence are right

                  Comment


                  • #10
                    saro
                    I think that the recurrence rate is more dependent on the surgeon than on the suture.
                    Bill Brown MD

                    Comment


                    • #11
                      but apart from the risk of recurrence, in permanent sutures there is a risk of granuloma (benign) but also greater complications? in absorbable sutures that of irritation ... we are perhaps too picky, the problems of surgery are others

                      Comment

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