- Mucosal surface to mucosal surface anastomosis (suture) is defined as valgus anastomosis
Serous membrane surface to serous membrane surface anastomosis (suture) is defined as varus suture
From 1826, when Lembert stressed the importance of serous membrane to serous membrane in gastrointestinal anastomosis (suture), surgeons have almost all adopted the varus suture method. But there are also experiments and clinical studies done by some foreign scholars that prove the feasibility of valgus anastomosis. Chinese scholar Cai Chengji also performed clinical experimental research. He proved valgus anastomosis is also safe and reliable, and can achieve the same healing effects as varus suture. Cai’s experimental observation of suture areas in 24-48 hours revealed a large amount of cellulose inflammatory exudate, in which the inflammatory cells were mostly polymorphonuclear leukocytes. In 72 hours fibroblasts and new small blood vessels appeared; a week later more organization tissue was formed on the serous surface. Inflammatory exudate is the material basis for healing. Regardless of the use of suturing method, allowing nutrients to reach the distal end of the suture is important. Mechanically stitched "B" shaped staples in principle can solve the problem, so in a sense, when the incisal end of sutured tissue shows a small amount of bleeding (of course, it is able to stop on its own), it is positive and beneficial for healing. Some doctors have no doubts about valgus sutures; they fear that the suture staples are in the body cavity and worry about the fate of the staples after coming off. Unlike varus sutures, they can be excreted from the digestive tract. In Cai’s experimental observations, he discovered the interesting phenomenon in observing the mucosal surface in valgus sutures: the specimens showed no staples 24-72 hours after surgery, but from one week to 35 days, there were staples visible in the mucosal suturing area, and they were slipping out in the direction of the intestines.