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

Needle-hole site leakage dominates after canine enterotomy; N:S ratio alone cannot guide commercial suture selection.

This ex vivo study investigated how needle-to-suture ratio (N:S Ratio) and suture diameter influence acute leakage pressure following jejunal enterotomy closure in dogs. Using 80 fresh jejunal segments from 10 canine cadavers, eight needle-suture product groups were evaluated in a randomized complete block design. Key outcome measures included initial leakage pressure (ILP), maximum intraluminal pressure (MIP), and the anatomical location of initial leakage. Linear mixed-effects models accounted for inter-dog variability. Strikingly, 93.75% of initial leakage events originated at needle-hole sites rather than at suture line gaps, highlighting needle-hole sealing as the dominant mechanical factor in acute leakage resistance. Suture group significantly affected both ILP and MIP. Under controlled, comparable needle-suture conditions, higher N:S Ratios were associated with lower acute leakage pressures, suggesting that needles proportionally larger than the suture create larger tissue defects with reduced sealing capacity. However, within a commercial suture series (SHMP), leakage pressure did not follow a simple monotonic relationship with N:S Ratio, indicating that additional product-specific factors—such as needle geometry, coating, and material properties—also contribute to performance. The authors conclude that while N:S Ratio is clinically relevant, it alone cannot predict the leakage resistance of commercial suture products. Further in vivo and clinical studies are needed before definitive needle-suture selection recommendations can be made for gastrointestinal surgery in dogs.

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