• Ahmad Hafez, Justiina Huhtakangas, Sajjad Muhammad, Michael T Lawton, Rokuya Tanikawa, and Mika Niemelä.
• Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: ext-ahmad.hafez@hus.fi/.
• World Neurosurg. 2019 Jan 1; 121: e119-e128.

BackgroundSeveral factors associated with interrupted and continuous suturing techniques affect the quality of bypass anastomosis. It is difficult to determine the impact of these factors during surgery. The primary objective of this study was to evaluate factors with the potential to influence the quality of bypass anastomosis using either interrupted or continuous suturing. A secondary objective was to evaluate the usefulness of a practical scale when comparing interrupted and continuous suturing techniques to improve bypass anastomosis.MethodsInterrupted (n = 100) and continuous (n = 100) suturing techniques were used in 200 end-to-side bypasses to a depth of 3 cm and were assessed by 5 neurosurgeons.ResultsVessel closing time (P < 0.001), stitch distribution (P < 0.001), intima-intima attachment (P < 0.001), and size of the orifice (P < 0.001) had a significant impact on the quality of the bypass regardless of the suturing technique used. The suturing technique used (interrupted or continuous) and positioning of the recipient vessel (vertical or horizontal) did not significantly influence the quality of anastomosis. Using multivariate analysis, the highest statistical significance with regard to bypass quality was attributed to the large size of the orifice and intimal attachment.ConclusionsThere were advantages and disadvantages to both suturing techniques. The scale was a practical way to measure and improve performance.Copyright © 2018 Elsevier Inc. All rights reserved.

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