Cushing and Connell Suture Patterns

The Connell and Cushing suture patterns are generally done in continuous fashion
and in general I began each of them by
performing a simple interrupted suture. It is very difficult on
this DASIE to actually perform the Cushing pattern because of how thin the intestinal wall is and so I will
demonstrate and purposely not try to penetrate the lumen
but it’s very difficult to do that technique and so if
there’s any suture material in the lumen obviously that’s a Connell suture pattern.
If there is not suture material in the lumen,
it’s a Cushing pattern. To begin, I would begin right at the
very end of the incision with a simple interrupted suture Once again I’m going to use my trusty
assistant and it’s very helpful to maintain your even tension to have an
assistant surgeon. Obviously for practice you may not have that luxury but in life it’s really nice to have
the assistant. Now both the Connell and Cushing are
horizontal sutures. You take about three or four
millimeters from the incision edge and you’re doing a
horizontal bite. In this case I’m deliberately trying
not to penetrate the lumen so I’m constructing
a Cushing suture and so I pull this through and I’m going
to come across the wound and do a similar bite on this side of the incision and as I pull this snug you’ll see that it will invert the intestinal wall. This is a very nice suture to
achieve serosa to serosa contact and you will notice that the difference between the Cushing and Connell and the Lembert is that as you pull this snug and get inversion you
cannot see the suture. The suture itself is buried using this horizontal technique of the Cushing
or Connell suture pattern. So one of the
advantages, potential advantages, at least
theoretically is that you have less suture material exposed by using one of
these Connell or Cushing or horizontally directed
patterns. One of the disadvantages is that you have the tendency to invert or you have a
tendency to invert more of the intestinal wall. You get a very nice
technique to achieve good inversion of the intestinal wall. To end this suture pattern, what I do you can always tie just across the bowel but I will reverse my needle and take a backhand suture bite and tie back to that loop. It’s always fair to
end by just tying back to the loop of your last suture however. So without penetrating the lumen it’s a
Cushing suture pattern and with penetrating the lumen it’s a Connell. this

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