B-Lynch Suture

’Surabaya Method’
(Modified B-Lynch Compression Suture)
 ’Surabaya Method’
(Modified B-Lynch Compression Suture)
• Performed by brace suturing techniques with 3 paralel
longitudinal stitches using chromic catgut no 2 with a curve
rounded needle straightened manually.

• The first stitch was introduced into uterine low segment ± 2

cm below Cesarean incision and medial of the lateral border or
at a same plane in PPH following vaginal delivery

• The needle was inserted at the ventral wall and let through
posterior wall of the uterine isthmus.
• The second stitch with new thread was performed with same
technique at contralateral site and the third also with a new
thread was done between the first and the second stitches.

• The assistant performed manual compression to the uterine

fundus to make anteflexed-inferior position while the operator
tightened the threads and tied the uterine fundus 3 cm medial
from left and right lateral border, and the third was tied
between them.
Figure 1. Surabaya Method Figure 2. Surabaya Method illustration.
(Modified B-Lynch suture).
The technique of Surabaya method
(step by step)

• Exteriorize the uterus, after vaginal delivery incision is not

needed in lower uterine segment (LUS) or the recent lower
segment (LS) Cesarean section was sutured.

• The assistant stretched up the uterus to make LUS thinner.

• The 1st stitch was placed ± 2 cm below LS incision or at same

plane after vaginal delivery and ± 2 cm medial of the lateral
border (Figure 2).
The technique of Surabaya method
(step by step)

• The needle was inserted from ventral to dorsal wall of the

LUS.

• The 2nd stitch was performed using the 1st stitch contra-
laterally (Figure 2).

• The 3rd stitch was performed between 1st and 2nd stitches
(Figure 2).

• The assistant compressed the uterus anterior-inferiorly to make

uterus in ante-flexed position.
The technique of Surabaya method
(step by step)

• The operator tied the 1st, 2nd and 3rd threads at the
fundus while assistant continued to compress the uterus.

• Before closing the abdomen, the second assistant checked

whether the bleeding had stopped or not.

• This technique using "Chromic catgut no. 2" with a curve

needle which had been straightened.
 A NEW UTERINE COMPRESSION SUTURE FOR
POSTPARTUM HAEMORRHAGE WITH ATONY
Department of Obstetrics, People’s Liberation Army 174th Hospital, Xiamen, Fujian, China
J Zheng, X Xiong, Q Ma, X Zhang, M Li
22 October 2010
Figure 1.
(A) The needle is inserted into the inner
layer of the anterior wall of the lower
segment and does not enter into the
myometrium.
(B) The needle is inserted into the middle
layer of the fundus.
(C) The needle is inserted into the inner
layer of the posterior wall of the lower
segment and does not enter into the
myometrium.
(D) The two ends of the thread are tied on
the fundus of the uterus. The procedure is
then repeated on the other side.
Figure 2. Perspective of the uterus after the knots are tied.
• the lower transverse uterine incision wa closed in one layer
with 1-polyglactin sutures first.

• Most of these women were placed in the semi lithotomy

position to allow assessment of vaginal bleeding. The uterus
was exteriorised. Bimanual compression was applied to check
whether this suture stopped the bleeding first

• and then a 1-polyglactin suture on a 40-mm curved needle was

inserted into the inner myometrial layer of the anterior wall of
the right lower segment, 2 cm below the incision.
• A 4 cm long insertion was made, 2 cm equidistant on each side
of the incision, 3 cm medial to the right lateral border, after the
bladder peritoneum where the bladder had been dissected
down (Figure 1A).

• The needle was then passed from the anterior, over the fundus,
and a 2 cm long insertion was made into the middle
myometrial layer, 4 cm medial to the right lateral border
(Figure 1B).

• A 3 cm long insertion was then made into the inner myometrial

layer of the posterior wall of the right lower segment, 2 cm
medial to the right lateral border (Figure 1C).
• The needle was not allowed to completely penetrate the entire
thickness of the wall to enter the uterine cavity.

• The two ends of the thread were tied on the fundus of the
uterus as tightly as possible, while a bimanual compression
was applied by an assistant (Figure 1D).

• The procedure was then repeated on the left (Figure 2)