When managing a full thickness small bowel injury, what is the recommended technique?

The recommended technique for managing a full thickness small bowel injury is double layer closure with suture lines perpendicular to the bowel. This approach is effective because it enhances the strength of the closure and minimizes the risk of leakage at the repair site.

In a double layer closure, the first layer primarily focuses on re-establishing the bowel wall integrity, while the second layer reinforces this closure, providing additional support to withstand intraluminal pressure during healing. Placing the suture lines perpendicular to the bowel helps to prevent any potential suture line dehiscence and ensures that the two layers of the repair do not align with each other, reducing stress on any one line of sutures.

This method is particularly important in the context of small bowel injuries where the risk of complications such as leakage or strictures can significantly affect patient outcomes. The extra support from a double layer reinforces the healing process within the bowel, which is crucial for a structure that needs to withstand considerable pressure from digestive contents.

Alternative techniques, such as a single layer closure, may not provide sufficient tensile strength, especially for larger or more complex tears. Delayed closure with absorbable sutures may expose the patient to higher risks of infectious complications or bowel obstruction during the waiting period for