Sutures and Wound Repair/ General Surgery (ABSA) Practice Test

In a two-layer bowel anastomosis, which layer is closed with absorbable sutures?

1. Outer serosal layer

2. Inner mucosal layer

3. Visceral peritoneum

4. Muscular layer

The correct answer is: Inner mucosal layer

In a two-layer bowel anastomosis, the inner mucosal layer is closed with absorbable sutures because this layer requires optimal healing and integration with the bowel contents. Absorbable sutures provide the necessary support during the critical healing period without the need for subsequent suture removal. This is essential because the mucosa is directly involved in the function of the bowel, facilitating nutrient absorption and maintaining the barrier against infections. The mucosal layer is usually more delicate and needs careful handling to promote proper healing, as it interfaces directly with the luminal contents. Using absorbable sutures allows for the necessary support during the early stages of healing while eventually being resorbed by the body, minimizing the risk of complications such as stitch abscesses or irritation from non-absorbable materials. In contrast, other layers like the outer serosal layer, visceral peritoneum, and muscular layer may be managed differently, often requiring stronger non-absorbable sutures for lasting support and structural integrity, especially in maintaining the overall strength of the anastomosis against luminal pressure.