Knotless backstitching provides comparable strength to conventional knotting in porcine stomach suture biomechanics

In this biomechanics study, we compared the use of knot fixation or backstitching at the end of a continuous suture with the use of conventional absorbable sutures to close a porcine stomach incision. We then evaluated whether the backstitching method could be considered a novel, surgical, knot-free closure technique. A total of 40 suturing samples were obtained and divided into 20 samples from the posterior wall and 20 from the anterior wall. These sets of 20 samples were then randomly grouped into the backstitching group and the knotting group, with 10 samples per group for each associated wall. Biomechanical tests were performed to compare the maximum load and tensile stiffness differences between the backstitching group and the knotting group. The maximum load and tensile stiffness differences between the backstitching group and the knotting group were not significant for the posterior or anterior walls of the porcine stomach. The use of backstitching at the end of an incision with continuous conventional absorbable sutures provides similar biomechanical properties to those of knot fixation, and the backstitching method shows promise as a novel surgical knot-free closure technique.