1
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Marano L, Cwalinski T, Girnyi S, Skokowski J, Goyal A, Malerba S, Prete FP, Mocarski P, Kania MK, Świerblewski M, Strzemski M, Suárez-Carreón LO, Herrera Kok JH, Polom K, Kycler W, Calu V, Talento P, Brillantino A, Ciarleglio FA, Brusciano L, Cillara N, Duka R, Pascotto B, Azagra JS, Calomino N, Testini M, Abou-Mrad A, Oviedo RJ, Vashist Y. Evaluating the Role of Robotic Surgery Gastric Cancer Treatment: A Comprehensive Review by the Robotic Global Surgical Society (TROGSS) and European Federation International Society for Digestive Surgery (EFISDS) Joint Working Group. Curr Oncol 2025; 32:83. [PMID: 39996883 PMCID: PMC11854667 DOI: 10.3390/curroncol32020083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Revised: 01/22/2025] [Accepted: 01/29/2025] [Indexed: 02/26/2025] Open
Abstract
INTRODUCTION Robot-assisted minimally invasive gastrectomy (RAMIG) represents a significant advancement in the surgical management of gastric cancer, offering superior dexterity, enhanced visualization, and improved ergonomics compared to laparoscopic gastrectomy (LG). This review systematically evaluates the current evidence on perioperative outcomes, oncological efficacy, learning curves, and economic considerations, providing insights into RAMIG's potential role in modern gastric cancer surgery. METHODS A thorough analysis of retrospective, prospective, and meta-analytic studies was conducted to compare RAMIG with LG. Key outcomes, including operative time, intraoperative blood loss, lymph node retrieval, postoperative complications, learning curve duration, and cost-effectiveness, were assessed. Emphasis was placed on both short-term and long-term oncological outcomes to determine the clinical value of RAMIG. RESULTS Evidence indicates that RAMIG is associated with reduced intraoperative blood loss, lower morbidity rates, and a shorter learning curve, with proficiency achieved after 11-25 cases compared to 40-60 cases for LG. The robotic platform's articulated instruments and enhanced three-dimensional visualization enable more precise lymphadenectomy, particularly in complex anatomical regions. Despite these advantages, operative time remains longer, and costs remain higher due to system acquisition, maintenance, and consumable expenses. However, emerging data suggest a gradual narrowing of cost disparities. While short-term outcomes are favorable, further high-quality, multicenter studies are needed to validate long-term oncological efficacy and survival outcomes. CONCLUSION RAMIG offers significant technical and clinical advantages over conventional LG, particularly in terms of precision and learning efficiency. However, the long-term oncological benefits and economic feasibility require further validation. Future research should focus on cost optimization, advanced technological integration such as near-infrared fluorescence and artificial intelligence, and multicenter trials to solidify RAMIG's role as a standard approach for gastric cancer surgery.
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Affiliation(s)
- Luigi Marano
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
- Department of Surgery, Dnipro State Medical University, Volodymyra Vernadskoho St. 9, 49044 Dnipro, Ukraine;
- Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Tomasz Cwalinski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Sergii Girnyi
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Jaroslaw Skokowski
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Aman Goyal
- Department of General Surgery, Mahatma Gandhi Medical College, Research Institute, Pondicherry, Cuddalore Rd., ECR, Pillayarkuppam 607402, Puducherry, India;
- Department of Medicine, Adesh Institute of Medical Sciences and Research, Bathinda 151001, Punjab, India
| | - Silvia Malerba
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70110 Bari, Italy; (F.P.P.); (M.T.)
| | - Francesco Paolo Prete
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70110 Bari, Italy; (F.P.P.); (M.T.)
| | - Piotr Mocarski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Magdalena Kamila Kania
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Maciej Świerblewski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Marek Strzemski
- Department of Anesthesiology and Intensive Care, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland;
| | - Luis Osvaldo Suárez-Carreón
- Department of Bariatric Surgery, UMAE Hospital de Especialidades del Centro Medico Nacional de Occidente, Guadalajara 44349, Mexico;
- Department of Surgery, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Johnn Henry Herrera Kok
- Department of Surgery, Complejo Asistencial Universitario de Palencia, 34401 Palencia, Spain;
| | - Karol Polom
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
| | - Witold Kycler
- Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
| | - Valentin Calu
- Department of Surgery, University of Medicine and Pharmacy Carol Davila, 010001 Bucharest, Romania;
| | - Pasquale Talento
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy;
| | | | | | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Nicola Cillara
- Department of Surgery, “SS. Trinità” Hospital, 09121 Cagliari, Italy
| | - Ruslan Duka
- Department of Surgery, Dnipro State Medical University, Volodymyra Vernadskoho St. 9, 49044 Dnipro, Ukraine;
| | - Beniamino Pascotto
- Department of General and Minimally Invasive Surgery (Laparoscopy & Robotic), Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg; (B.P.); (J.S.A.)
| | - Juan Santiago Azagra
- Department of General and Minimally Invasive Surgery (Laparoscopy & Robotic), Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg; (B.P.); (J.S.A.)
| | - Natale Calomino
- Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70110 Bari, Italy; (F.P.P.); (M.T.)
| | - Adel Abou-Mrad
- Department of Surgery, Centre Hospitalier Universitaire d’Orléans, 45000 Orléans, France;
| | - Rodolfo J. Oviedo
- Department of Surgery, Nacogdoches Medical Center, Nacogdoches, TX 75962, USA
- Department of Surgery, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77001, USA
- Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, TX 77301, USA
| | - Yogesh Vashist
- Department of Surgery, Organ Transplant Center for Excellence, Center for Liver Diseases and Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 12271, Saudi Arabia;
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Ataya K, Patel N, Yang W, Aljaafreh A, Melebari SS. Safety and Efficacy of Barbed Sutures Compared to Non-barbed Sutures in Bariatric Surgery: An Updated Systematic Review and Meta-analysis. Obes Surg 2024; 34:3324-3334. [PMID: 39078450 DOI: 10.1007/s11695-024-07382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Mastering intracorporeal suturing is challenging in the evolution from conventional to laparoscopic bariatric surgery. Among various techniques competing for superiority in overcoming this hurdle, we focus on exploring the potential of barbed sutures through a meta-analysis that compares outcomes to those of conventional non-barbed sutures in bariatric surgery. MATERIALS AND METHODS We conducted a comprehensive search on PubMed, Scopus, and Embase to identify studies comparing barbed sutures with non-barbed sutures in bariatric surgeries, focusing on outcomes such as operative time, suturing time, postoperative complications, and hospital stay. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. RESULTS Incorporating data from 11 studies involving a total of 27,442 patients, including 3,516 in the barbed suture group across various bariatric surgeries, our analysis demonstrates a significant reduction in suturing time (mean difference -4.87; 95% CI -8.43 to -1.30; p < 0.01; I2 = 99%) associated with the use of barbed sutures. Specifically, in Roux-en-Y gastric bypass, we observed a significant decrease in operative time (mean difference -12.11; 95% CI -19.27 to -4.95; p < 0.01; I2 = 93%). Subgroup analyses and leave-one-out analyses consistently supported these findings. Furthermore, we found that the mean body mass index did not significantly predict the mean difference in operative time outcome. No significant differences emerged in hospital stay or postoperative complications, including leak, bleeding, stenosis, and bowel obstruction (p > 0.05). CONCLUSION Our study findings address barbed sutures as a potential alternative for laparoscopic intracorporeal suturing in bariatric surgery.
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Affiliation(s)
- Karim Ataya
- Department of Bariatric Surgery, University of Montreal, Montreal, H3C 3J7, Canada
| | - Neha Patel
- Department of General Surgery, Government Medical College Surat, Surat, 395001, India
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Almoutuz Aljaafreh
- Department of Bariatric Surgery, St Georges University Hospitals NHS Foundation Trust, London, SW17 0QT, England
| | - Samah Sofyan Melebari
- Department of Bariatric Surgery, King Abdullah Medical City, Makkah, 24246, Saudi Arabia
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Reynolds E, Bergeron T, Shapiro K, Abraham N. Bowel Complications Due to Barbed Suture (V-LOCK) Use During Sacrocolpopexy. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:461-465. [PMID: 37738015 DOI: 10.1097/spv.0000000000001417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
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Costa G, Garbarino GM, Lepre L, Liotta G, Mazzoni G, Gabrieli A, Costa A, Podda M, Sganga G, Fransvea P. Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture. J Clin Med 2024; 13:1242. [PMID: 38592114 PMCID: PMC10931710 DOI: 10.3390/jcm13051242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/26/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Peptic ulcers result from imbalanced acid production, and in recent decades, proton pump inhibitors have proven effective in treating them. However, perforated peptic ulcers (PPU) continue to occur with a persistent high mortality rate when not managed properly. The advantages of the laparoscopic approach have been widely acknowledged. Nevertheless, concerning certain technical aspects of this method, such as the best gastrorrhaphy technique, the consensus remains elusive. Consequently, the choice tends to rely on individual surgical experiences. Our study aimed to compare interrupted stitches versus running barbed suture for laparoscopic PPU repair. Methods: We conducted a retrospective study utilizing propensity score matching analysis on patients who underwent laparoscopic PPU repair. Patients were categorised into two groups: Interrupted Stitches Suture (IStiS) and Knotless Suture (KnotS). We then compared the clinical and pathological characteristics of patients in both groups. Results: A total of 265 patients underwent laparoscopic PPU repair: 198 patients with interrupted stitches technique and 67 with barbed knotless suture. Following propensity score matching, each group (IStiS and KnotS) comprised 56 patients. The analysis revealed that operative time did not differ between groups: 87.9 ± 39.7 vs. 92.8 ± 42.6 min (p = 0.537). Postoperative morbidity (24.0% vs. 32.7%, p = 0.331) and Clavien-Dindo III (10.7% vs. 5.4%, p = 0.489) were more frequently observed in the KnotS group, without any significant difference. In contrast, we found a slightly higher mortality rate in the IStiS group (10.7% vs. 7.1%, p = 0.742). Concerning leaks, no differences emerged between groups (3.6% vs. 5.4%, p = 1.000). Conclusions: Laparoscopic PPU repair with knotless barbed sutures is a non-inferior alternative to interrupted stitches repair. Nevertheless, further research such as randomised trials, with a standardised treatment protocol according to ulcer size, are required to identify the best gastrorraphy technique.
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Affiliation(s)
- Gianluca Costa
- Surgery Center, Colorectal Surgery Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | | | - Luca Lepre
- General and Emergency Surgery Unit, Santo Spirito in Sassia Hospital, ASL Roma 1, 00193 Rome, Italy;
| | - Gianluca Liotta
- General and Emergency Surgery Unit, Palestrina Hospital, ASL Roma 6, 00036 Palestrina, Italy
| | - Gianluca Mazzoni
- General Surgery Unit, G.B. Grassi Hospital, ASL Roma 3, 00122 Rome, Italy
| | - Alice Gabrieli
- Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy;
| | - Alessandro Costa
- UniCamillus School of Medicine, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy;
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, 00135 Rome, Italy (P.F.)
| | - Pietro Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, 00135 Rome, Italy (P.F.)
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Pennestrì F, Sessa L, Prioli F, Gallucci P, Salvi G, Procopio PF, Martullo A, Petrazzuolo E, Di Lorenzo S, Ciccoritti L, Giustacchini P, Greco F, Revelli L, Marincola G, Laurino A, De Crea C, Raffaelli M. Barbed vs. Conventional Sutures in Bariatric Surgery: Early and Late Outcomes. SURGERIES 2023; 4:461-470. [DOI: 10.3390/surgeries4030045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Abstract
The implementation of barbed sutures appears to enhance the process of suturing and knot tying, particularly in the field of bariatric surgery, where they can offer significant advantages. The objective of this study is to evaluate the safety and effectiveness of utilising barbed sutures for gastric pouch-jejunal anastomosis (GPJA) and jejuno-jejunal anastomosis (JJA) anastomosis in Roux-en-Y Gastric Bypass (RYGB). Data from patients who underwent primary RYGB between January 2012 and October 2018 were retrospectively collected using Propensity Score Matching (PSM) to randomise groups (barbed sutures—BS-G and conventional sutures—CS-G). The primary outcome was postoperative early complications. The secondary outcomes were late complications (internal hernias and small bowel obstructions), operative time and postoperative hospital stay. A total of 969 patients were included. After PSM, 322 (161 in BS-G vs. 161 in CS-G) patients were compared (chi-square 0.287, p = 0.862). Postoperative early and late complications were comparable between the two groups. BS-G had a significantly shorter median operative time (65 vs. 95 min p < 0.001). Median postoperative hospital stay was significantly shorter for BS-G (2 vs. 5 days, p < 0.001). Barbed sutures effectively reduce the operation duration and are as safe as conventional sutures for closing anastomotic defects during RYGB.
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Affiliation(s)
- Francesco Pennestrì
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Sessa
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Istituto G. Giglio di Cefalù, 90015 Cefalù, Italy
| | - Francesca Prioli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giulia Salvi
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Priscilla Francesca Procopio
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Annamaria Martullo
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Eleonora Petrazzuolo
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sofia Di Lorenzo
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Ciccoritti
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Piero Giustacchini
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Greco
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Luca Revelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Marincola
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Laurino
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Ban B, Shang A, Shi J. Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery. World J Gastrointest Surg 2022; 14:821-832. [PMID: 36157360 PMCID: PMC9453327 DOI: 10.4240/wjgs.v14.i8.821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/28/2022] [Accepted: 07/26/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Anastomotic leakage (AL) is a severe complication in rectal cancer surgery. Various methods, including intracorporeal reinforcing suturing, have been used to reduce the incidence of AL. However, little is known about the efficacy of staple-line reinforcement by barbed suture for preventing AL.
AIM To evaluate the efficacy of staple-line reinforcement using barbed suture for preventing AL in laparoscopic surgery for rectal cancer.
METHODS We retrospectively reviewed the clinical datum of 319 patients undergoing laparoscopic low anterior resection combined with double stapling technique between May 1, 2017 and January 31, 2021. All surgeries were performed by the same surgical team specializing in colorectal surgery. Patients were divided into two groups depending on whether they received reinforcing sutures. Patients’ baseline characteristics did not show any significant difference between the two groups. We analyzed patient-, tumor-, as well as surgery-related variables using univariate and multivariate logistic analyses.
RESULTS There were 168 patients in the reinforcing suture group and 151 patients in the non-reinforcing suture group. AL occurred in 25 cases (7.8%). Its incidence was significantly higher in the non-reinforcing suture group than in the reinforcing suture group (4.8% vs 11.3%, P = 0.031). The multivariate analyses demonstrated that the tumor site, tumor size and presence of staple-line reinforcement were independent risk factors for AL. We divided these patients into two risk groups based on the combination of tumor site and tumor size. Patients without any risk factor were assigned to the low-risk group (n = 177), whereas those having one or two risk factors were assigned to the high-risk group (n = 142). In the high-risk group, the AL incidence considerably decreased in the reinforcing suture group compared with that in the non-reinforcing suture group (P = 0.038). Nonetheless, no significant difference was found in the low-risk group between the two groups.
CONCLUSION Staple-line reinforcement by barbed suture may decrease the incidence of AL. A large-scale prospective randomized controlled trial is needed for evaluating the efficacy of staple-line reinforcement for preventing AL.
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Affiliation(s)
- Bo Ban
- Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - An Shang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jian Shi
- Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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7
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Duffy DJ, Chang YJ, Moore GE. Influence of barbed suture oversew of the transverse staple line during functional end-to-end stapled anastomosis in a canine jejunal enterectomy model. Vet Surg 2022; 51:801-808. [PMID: 35614547 PMCID: PMC9324082 DOI: 10.1111/vsu.13827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/14/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the influence of barbed suture oversew of the transverse staple line during functional end‐to‐end stapled anastomosis (FEESA) in dogs. Study design Randomized, experimental, ex vivo. Animals or sample population Grossly normal jejunal segments from 14 adult canine cadavers. Methods Ninety‐eight jejunal segments (n = 14/FEESA group, n = 14 controls) were harvested and randomly assigned to a control group, FEESA + monofilament suture oversew, FEESA + unidirectional barbed suture oversew or FEESA + bidirectional barbed suture oversew. Oversew techniques were performed using a Cushing suture pattern. Initial (ILP) and maximum leakage pressure (MLP), repair time (s), and location of observed leakage were recorded. Results No differences were detected in ILP (p = .439) or MLP (p = .644) respectively between experimental groups. Repairs times using barbed suture were ~ 18% faster (~25 s faster; p < .001) compared to monofilament suture. There was no difference between barbed suture types (p = .697). Mean ILP (p < .001) and MLP (p < .0001) were 6.6x and 5.1x greater respectively in the control group. Leakage location occurred predominately at the crotch of the FEESA in all groups. Conclusion FEESAs closed with a transverse staple line oversew using barbed suture, regardless of barb orientation, were completed faster and resulted in similar resistance to anastomotic leakage compared to monofilament suture. Clinical significance Oversewing the transverse staple line following FEESA using barbed suture offers similar resistance to anastomotic leakage, and may be associated with decreased surgical times in dogs compared to monofilament suture. Further studies are necessary to determine the benefits of barbed suture use in both open and laparoscopic gastrointestinal surgical applications following FEESA in dogs.
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Affiliation(s)
- Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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8
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Velotti N, Manigrasso M, Di Lauro K, Vertaldi S, Anoldo P, Vitiello A, Milone F, Musella M, De Palma GD, Milone M. Barbed suture in gastro-intestinal surgery: A review with a meta-analysis. Surgeon 2022; 20:115-122. [PMID: 33820730 DOI: 10.1016/j.surge.2021.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/06/2020] [Accepted: 02/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The laparoscopic approach is a very popular technique for many gastrointestinal operations and barbed sutures may improve the difficulties of intracorporeal anastomosis by eliminating the need for knot tying. The aim of this systematic review with a meta-analysis is to explore literature to establish the security profile of barbed suture compared with conventional laparoscopic sutures. MATERIALS AND METHODS A systematic search was performed in all electronic databases (PubMed, Web of Science, Scopus, EMBASE) and 12 studies were included in the analysis, involving 27,133 patients, whereof 3372 cases (patients undergone barbed suture usage) and 23,761 controls (patients undergone conventional suture usage). We found 3 studies discussing differences between barbed and conventional sutures in colorectal surgery and 8 studies presenting results in bariatric surgery, both in Roux-en-y gastric bypass and Mini Gastric/One Anastomosis Gastric Bypass. RESULTS We found comparable rate of leaks, bleedings and stenosis. The meta-regression analysis demonstrated that, both in case of bariatric and colorectal surgery, the demographic characteristic of patients and the oncological features of neoplasms did not impact of these findings. As expected, operative time is significantly shorter when barbed suture is used. CONCLUSION Our analysis on current literature define an acceptable security profile for barbed suture with effective results particularly in terms of shorter operative time.
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Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Katia Di Lauro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Pietro Anoldo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonio Vitiello
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesco Milone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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9
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Chang YJ, Duffy DJ, Moore GE. Influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure. Vet Surg 2021; 50:1502-1509. [PMID: 34405426 DOI: 10.1111/vsu.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/12/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure. STUDY DESIGN Randomized, experimental, cadaveric. ANIMALS OR SAMPLE POPULATION Grossly normal jejunal segments from three canine cadavers. METHODS Jejunal segments were harvested and randomly assigned based upon effector loop location from the beginning of the incisional line. Groups (n = 12/group) included 0 mm, 5 mm, 10 mm, 15 mm, and intact controls (n = 6/group), repaired using a 3-0 unidirectional barbed suture in a simple continuous pattern. Initial leakage pressure (ILP), maximum intraluminal pressure (MIP), repair time, and leakage location were recorded. RESULTS Mean ILP for 0 mm group (24.42 ± 8.43 mmHg) was lower (p ≤ .001) compared to all experimental groups with ILP ~40% lower. There was no difference in MIP among experimental groups (p = .239). Repair time increased (p < .0001) as the distance of the effector loop increased ≥5 mm from the beginning of the incisional line. Leakage location differed among groups (p < .001) with leakage in the 0 mm group from the incisional line (75%), compared to leakage from predominantly from the suture holes in other groups, respectively. CONCLUSION Effector loop location influenced ILP and leakage location. Effector loops placed at the beginning of the incisional line (0 mm) decreased ILP compared to loops placed at 5, 10, and 15 mm. CLINICAL SIGNIFICANCE Effector loop location using a unidirectional barbed suture should be placed ≥5 mm from beginning of the incisional line for enterotomy closure. Further in vivo studies are necessary to determine the clinical significance of these findings.
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Affiliation(s)
- Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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10
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Ferrer-Márquez M, Rubio-Gil F, Torres-Fernández R, Moya-Forcén P, Belda-Lozano R, Arroyo-Sebastián A, Benavides-Buleje J, Reina-Duarte A. Intracorporeal Versus Extracorporeal Anastomosis in Patients Undergoing Laparoscopic Right Hemicolectomy: A Multicenter Randomized Clinical Trial (The IVEA-study). Surg Laparosc Endosc Percutan Tech 2021; 31:408-413. [PMID: 33935256 DOI: 10.1097/sle.0000000000000937] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy for right colon neoplasm. BACKGROUND Despite advances in the laparoscopic approach in colorectal surgery and the clear benefit of this approach over open surgery, because of the technical difficulty in performing intracorporeal anastomosis (IA), some continue to perform it extracorporeally in right colon surgery. MATERIALS AND METHODS This study was a prospective multicenter randomized trial with 2 parallel groups on which either IA or extracorporeal anastomosis was performed in laparoscopic right hemicolectomy for right colon neoplasm, carried out between January 2016 and December 2018. RESULTS A total of 168 patients were randomized during the study period. At baseline, the 2 groups were comparable for age, sex, body mass index, surgical risk, and comorbidity. The median length of postoperative hospital stay was 7 days with no differences between the groups. About 70% of patients had an uneventful postoperative period without complications. The most common complications were paralytic ileus (20.63%; 33), surgical site infection (SSI) (10%; 16), and anastomotic leakage (6.25%; 10). The results show a lower level of SSI in the IA group (3.65% vs. 16.67%, P=0.008). Other complications do not show statistically significant differences between groups. Likewise, the incision for the extraction of the specimen was smaller in the IA group (P=0.000) and creation of the anastomosis intracorporeally decreased postoperative pain (P=0.000). CONCLUSIONS In comparison to the extracorporeal technique, IA decreased postoperative pain, incision size, and SSI. Further studies will be needed to verify our findings.
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Affiliation(s)
- Manuel Ferrer-Márquez
- Department of General Surgery, Division of Colorectal Surgery, University Hospital of Torrecárdenas, Almeria
| | - Francisco Rubio-Gil
- Department of General Surgery, Division of Colorectal Surgery, University Hospital of Torrecárdenas, Almeria
| | - Rocio Torres-Fernández
- Department of General Surgery, Division of Colorectal Surgery, University Hospital of Torrecárdenas, Almeria
| | - Pedro Moya-Forcén
- Department of General Surgery, Division of Colorectal Surgery, University Hospital of Torrecárdenas, Almeria
| | - Ricardo Belda-Lozano
- Department of General Surgery, Division of Colorectal Surgery, University Hospital of Torrecárdenas, Almeria
| | - Antonio Arroyo-Sebastián
- Department of General Surgery, Division of Colorectal Surgery, University General Hospital, Elche
| | - Jorge Benavides-Buleje
- Department of General Surgery, Division of Colorectal Surgery, Hospital Reina Sofia, Murcia, Spain
| | - Angel Reina-Duarte
- Department of General Surgery, Division of Colorectal Surgery, University Hospital of Torrecárdenas, Almeria
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11
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Jiang TY, Zang L, Dong F, Feng B, Zong YP, Sun J, Liu HS, Zheng MH, Ma JJ. Effect of different reinforcement methods on anastomotic leakage prevention after laparoscopic double anastomosis. J Surg Oncol 2021; 123 Suppl 1:S81-S87. [PMID: 33740257 DOI: 10.1002/jso.26333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES To investigate the effects of different suture reinforcement methods for anastomotic leakage and other postoperative complications after the use of a laparoscopic double stapling technique (DST). METHODS We collected the data of 124 patients who underwent laparoscopic radical resection of colorectal cancer from July 2017 to September 2018 at our institution. Patients were divided into three groups according to the suture reinforcement methods: intermittent, continuous suture reinforcement, and non-reinforcement (n = 41, 41, and 42, respectively). One-way analysis of variance, χ2 , Fisher's exact, and nonparametric tests were used for statistical analysis. RESULTS Among the 124 patients, there were no statistically significant differences in operation times, intraoperative blood loss, postoperative hospital stays and recovery of bowel movement. Nine patients were diagnosed with anastomotic leakage (AL). The incidences of serious AL in the intermittent and continuous suture reinforcement groups were lower than that in the control group, with lower reoperation rate, shorter average lengths of stay and lower treatment costs of two experimental groups. CONCLUSION Intermittent and continuous sutures after laparoscopic DST is effective, safe, and feasible on anastomotic leakage prevention. These procedures could be popularized in rectal surgery on patients with high risk of AL.
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Affiliation(s)
- Tian-Yu Jiang
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Dong
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Feng
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Ya-Ping Zong
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Sun
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Hai-Shan Liu
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Min-Hua Zheng
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jun-Jun Ma
- Department of General Surgery, Shanghai Jiao Tong University, Shanghai, 200025, China.,Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University, Shanghai, China
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12
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Kim DW, Song S, Jee YS. Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:311. [PMID: 33708938 PMCID: PMC7944262 DOI: 10.21037/atm-20-3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Perforated peptic ulcer (PPU) is a fatal complication of peptic ulcer disease, which requires emergency surgery. Laparoscopic repair is the widely accepted and effective method for the treatment of PPU. The aim of this study was to evaluate the safety and efficacy of duet laparoscopic repair of PPU with knotless barbed sutures. Methods From January 2013 to May 2019, 40 patients with PPU underwent laparoscopic primary repair and omentopexy at the Dankook University Hospital. The operative outcomes and complications of patients undergoing surgery using continuous suturing with absorbable knotless barbed sutures (group A, n=15) were compared with those undergoing surgery with conventional interrupted sutures (group B, n=25). Results The mean operative time was significantly shorter in group A than group B (84.4±39.8 vs. 104.2±49.4 min, P<0.001). There were no differences in other operative outcomes or postoperative complications (group A vs. group B, 20.0% vs. 24.0%, respectively; P=0.249) between the two groups. The mean operation time spent for laparoscopic sutures and omentopexy was 22.7 minutes. Conclusions The findings of the current study, albeit performed retrospectively at a single institution, suggested that duet laparoscopic repair of PPU with knotless barbed sutures might be considered as an alternative option, especially in hospitals lacking manpower.
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Affiliation(s)
- Dong-Wook Kim
- Department of Surgery, Dankook University College of Medicine, Chungnam, Republic of Korea
| | - Sanghyun Song
- Department of Surgery, Dankook University College of Medicine, Chungnam, Republic of Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University College of Medicine, Chungnam, Republic of Korea
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13
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Chaouch MA, Kellil T, Taieb SK, Zouari K. Barbed versus conventional thread used in laparoscopic gastric bypass: a systematic review and meta-analysis. Langenbecks Arch Surg 2020; 406:1015-1022. [PMID: 32857247 DOI: 10.1007/s00423-020-01979-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hand-sewn gastrointestinal anastomosis during laparoscopic gastric bypass (GBP) could be performed using the conventional multifilament suture (CS) or a barbed suture (BS). This systematic review with meta-analysis aimed to assess the advantages and disadvantages of these two anastomosis alternatives. METHODS Bibliographic search for relevant studies was performed, according to the PRISMA guidelines, to perform the systematic review with meta-analysis. RevMan was applied to analyze the data using the random effects size. RESULTS Eight studies were eligible for analysis including 26,340 patients. These patients underwent a single gastric bypass or Roux-en-Y gastric bypass. According to the available data from this systematic review with meta-analysis, BS in GBP ensures similar morbidity rate (OR = 1.04, 95% CI: 0.82 to 1.31, p = 0.74) with shorter operative time (MD = - 7.90, 95% CI: - 12.95 to - 2.84, p = 0.002). BS is similar to CS in terms of anastomotic leak (OR: 1.25, 95% CI: 0.90 to 1.73, p = 0.19), stricture (OR: 0.89, 95% CI: 0.32 to 2.44, p = 0.82), bleeding (OR: 0.62, 95% CI: 0.20 to 1.86, p = 0.39), and hospital stay (MD: 0.04, 95% CI: - 0.28 to 1.86, p = 0.81). On the other way, BS is cheaper than CS. CONCLUSION The majority of studies were retrospectives. One study included the large majority of retained patients; thus then, this comparison should be interpreted with caution. BS and CS in gastrointestinal anastomosis during GBP are feasible and safe. BS is faster and cheaper with similar postoperative outcomes.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia.
| | - Tarek Kellil
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia
| | - Sahbi Khaled Taieb
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia
| | - Khadija Zouari
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia
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14
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Wiggins T, Majid MS, Markar SR, Loy J, Agrawal S, Koak Y. Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. Ann R Coll Surg Engl 2020; 102:153-159. [PMID: 31508982 PMCID: PMC6996435 DOI: 10.1308/rcsann.2019.0106] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Anastomosis formation constitutes a critical aspect of many gastrointestinal procedures. Barbed suture materials have been adopted by some surgeons to assist in this task. This systematic review and meta-analysis compares the safety and efficacy of barbed suture material for anastomosis formation compared with standard suture materials. METHODS An electronic search of Embase, Medline, Web of Science and Cochrane databases was performed. Weighted mean differences were calculated for effect size of barbed suture material compared with standard material on continuous variables and pooled odds ratios were calculated for discrete variables. FINDINGS There were nine studies included. Barbed suture material was associated with a significant reduction in overall operative time (WMD: -12.87 (95% CI = -20.16 to -5.58) (P = 0.0005)) and anastomosis time (WMD: -4.28 (95% CI = -6.80 to -1.75) (P = 0.0009)). There was no difference in rates of anastomotic leak (POR: 1.24 (95% CI = 0.89 to 1.71) (P = 0.19)), anastomotic bleeding (POR: 0.80 (95% CI = 0.29 to 2.16) (P = 0.41)), or anastomotic stricture (POR: 0.72 (95% CI = 0.21 to 2.41) (P = 0.59)). CONCLUSIONS Use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding or stricture) compared with standard suture materials.
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Affiliation(s)
- T Wiggins
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - MS Majid
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - SR Markar
- Department of Surgery and Cancer, Imperial College London, UK
| | - J Loy
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - S Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - Y Koak
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
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Ferrer-Márquez M, Torres-Fernández R, Rubio-Gil F, Belda-Lozano R, Moya-Forcén P, Benavides Buleje JA, Reina-Duarte Á. Use of barbed suture for the closure of enterocolotomy after laparoscopic right hemicolectomy with intracorporeal anastomosis. A prospective descriptive study. Cir Esp 2019; 98:136-142. [PMID: 31813550 DOI: 10.1016/j.ciresp.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/01/2019] [Accepted: 10/20/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Performing intracorporeal anastomoses and sutures is possibly the technique that requires the greatest skill in laparoscopic surgery. The appearance of the new barbed sutures in recent years has seemed to facilitate this surgical step. The aim of our study is to evaluate short-term results in patients with neoplasms of the right colon, after laparoscopic right hemicolectomy with intracorporeal anastomosis using barbed suture at the closure of the enterocolotomy. METHODS This is a multicenter, prospective, descriptive study that includes patients who underwent laparoscopic right hemicolectomy for neoplastic colonic pathologies between June 2015 and December 2018. In all patients, the intracorporeal anastomosis was performed using the endocutter, and closure of the enterocolotomy was done with a double layer of barbed suture. RESULTS A total of 80 patients were treated (47.5% women), with an average age of 70.6±9 (49-92) years. The average operative time was 99.5±38minutes Anastomotic dehiscence was observed in 2.5% of the sample, and 5 patients required re-operation (6.2%) as a result of 2leaks, 2obstructive symptoms and one peritoneal bleeding. Mean hospital stay was 7 (3-173) days. CONCLUSIONS The use of barbed suture in laparoscopic right hemicolectomy with intracorporeal anastomosis seems to present a morbidity similar to series described in literature. Prospective, controlled and randomized studies with a larger number of patients would be necessary to confirm these findings.
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Affiliation(s)
- Manuel Ferrer-Márquez
- Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España.
| | - Rocio Torres-Fernández
- Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España
| | - Francisco Rubio-Gil
- Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España
| | - Ricardo Belda-Lozano
- Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España
| | - Pedro Moya-Forcén
- Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España
| | - Jorge Alejandro Benavides Buleje
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, España
| | - Ángel Reina-Duarte
- Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España
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Bures C, Seika P, Denecke C, Pratschke J, Zorron R. ROUTINE USE OF V-LOCK® SUTURE FOR BARIATRIC ANASTOMOSIS IS SAFE: COMPARATIVE RESULTS FROM CONSECUTIVE CASE SERIES. ACTA ACUST UNITED AC 2019; 32:e1452. [PMID: 31644672 PMCID: PMC6812141 DOI: 10.1590/0102-672020190001e1452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/02/2019] [Indexed: 01/31/2023]
Abstract
Background:
In high-income countries, morbid obesity is a growing health problem that
has already reached epidemic proportions. When performing a laparoscopic
gastric bypass several operative methods exist.
Aim:
To describe the institutional experience using a knotless unidirectional
barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn
gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery.
Methods:
Evaluation of a case series of 87 morbidly obese patients who underwent
laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and
jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were
divided into two groups: in group I, GJA und JJA sutures were performed
using the knotless unidirectional barbed suture; in group II, GJA and JJA
were sutured with resorbable multifilament thread (Vicryl® 3/0
Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score,
operative time, postoperative morbidity, length of hospital stay, and
reoperation, were analyzed and compared.
Results:
All procedures were completed laparoscopically with no mortality. The mean
operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group
II (p<0.05). The postoperative complications did not differ significantly
between the two groups. Early complications were observed for two patients
(0.9%) in the barbed suture group and for one patient (0.42%) in the
multifilament suture group (p<0.05). In group I two patients (0.9%)
required reoperation: on the basis of jejunojejunal stenosis in one patient,
and local abscess near the gastrojejunostomy, without a leakage, in the
other. In group II one patient (0.42%) required reoperation due to stenosis
of the GJA. The duration of hospital admission was similar for both groups:
3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II
(p<0.05).
Conclusion:
The novel anastomotic technique is a safe and effective method and can be
applied to gastrojejunal anastomosis and jejunojejunal anastomosis in
laparoscopic gastric bypass.
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Affiliation(s)
- Claudia Bures
- Center for Bariatric and Metabolic Surgery, Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philippa Seika
- Center for Bariatric and Metabolic Surgery, Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Denecke
- Center for Bariatric and Metabolic Surgery, Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Center for Bariatric and Metabolic Surgery, Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ricardo Zorron
- Center for Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann Potsdam, Potsdam, Germany
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The Effectiveness and Safety of Barbed Sutures in the Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2019; 29:1756-1764. [PMID: 30778845 DOI: 10.1007/s11695-019-03744-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Barbed vs conventional sutures in bariatric surgery: a propensity score analysis from a high-volume center. Updates Surg 2018; 71:113-120. [DOI: 10.1007/s13304-018-0589-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
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Kim TH, Park JH, Jeong SH, Lee JK, Kwag SJ, Kim JY, Lee W, Woo JW, Jang JY, Song EJ, Park T, Jeong CY, Ju YT, Jung EJ, Hong SC, Choi SK, Ha WS, Lee YJ. Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation. Surg Endosc 2018; 32:3667-3674. [PMID: 29470633 DOI: 10.1007/s00464-018-6099-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/07/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic primary repair is one of the main procedures used for perforated gastric ulcers, and this technique requires reproducible and secure suturing. The aim of this study was to investigate the safety and efficacy of a novel continuous suture method with barbed sutures during laparoscopic repair for perforated peptic ulcers. PATIENTS AND METHODS Clinical data from 116 consecutive patients undergoing laparoscopic repair for perforated peptic ulcers were collected between November 2009 and October 2015. Continuous suturing with 15-cm-long unidirectional absorbable barbed sutures was used for laparoscopic repair in the study group, termed group V (n = 51). Patients who underwent laparoscopic repair with conventional interrupted sutures were defined as group C (n = 65). The complication and operative data were compared between groups. RESULTS Although there was no difference between group V and group C in the overall complication rate (15.7% vs. 24.6%; p = 0.259), the complication rate related to suturing was lower (3.9% vs. 15.4%; p = 0.04) in group V. Group V showed rates of 0% for leakage, 2% for intra-abdominal fluid collection, and 2% for stricture; the corresponding rates in group C were 3.1, 7.7, and 4.6%, respectively. Regarding operative data, the total operation time (V vs. C, 87.7 min vs. 131.2 min), total suture time (7.1 min vs. 25.3 min), and suture time per stitch (1.2 min vs. 6.2 min) were significantly shorter in group V than in group C (p < 0.001). CONCLUSION The use of a continuous suture technique with unidirectional barbed sutures is as safe as the conventional suture technique and allows easier and faster suturing in the repair of perforated peptic ulcers.
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Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Jin-Kwon Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Woohyung Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Jung-Woo Woo
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Jae Yool Jang
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Eun-Jin Song
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Sang-Kyung Choi
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Woo-Song Ha
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.
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Feroci F, Giani I, Baraghini M, Romoli L, Zalla T, Quattromani R, Cantafio S, Scatizzi M. Barbed versus traditional suture for enterotomy closure after laparoscopic right colectomy with intracorporeal mechanical anastomosis: a case–control study. Updates Surg 2017; 70:433-439. [DOI: 10.1007/s13304-017-0502-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022]
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Pilkinton ML, Levine GC, Bennett L, Winkler HA, Shalom DF, Finamore PS. Comparison of strength of sacrocolpopexy mesh attachment using barbed and nonbarbed sutures. Int Urogynecol J 2017; 29:153-159. [DOI: 10.1007/s00192-017-3451-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
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Gys B, Gys T, Lafullarde T. The Use of Unidirectional Knotless Barbed Suture for Enterotomy Closure in Roux-en-Y Gastric Bypass: a Randomized Comparative Study. Obes Surg 2017; 27:2159-2163. [PMID: 28281235 DOI: 10.1007/s11695-017-2628-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE In this study, we assessed feasibility, safety, and time efficiency of laparoscopic running enterotomy closure for linear stapled Roux-en-Y Gastric Bypass (RYGB) using unidirectional barbed sutures (Stratafix™ 2/0- Ethicon). MATERIALS AND METHODS Two hundred patients undergoing laparoscopic RYGB were prospectively randomized regarding running enterotomy closure of the linear stapled gastrojejunal (GJA) and jejunojejunal anastomosis (JJA). Two groups were created: V-group (Vicryl® 2/0-Ethicon) and S-group (Stratafix™ 2/0-Ethicon). Time spent on closing the enterotomies was measured from first needle in until knot and cut (V-group) or last stitch and cut (S-group). If needed, a nonabsorbable "correction" ("c"; in order to close a small hiatus at the anastomosis) or hemostatic ("h") stitch was made (using a single Prolene® 2/0-Ethicon). RESULTS Average total procedure time was similar (S-group 1:01:22, V-group 1:00:44, P = 0.340). Closure of the enterotomy (GJA) was significantly shorter in the S-group (07:41 min versus 08:13 min in the V-group, P = 0.005). Extra stitches (GJA) were performed in 33 patients (16.5%): 3 (h) and 20 (c) in the V-group and 1 (h) and 9 (c) in the S-group. Four patients in the V-group suffered from postoperative intraluminal bleeding (3 self-limiting, 1 underwent endoscopic clipping). In the S-group, 1 patient suffered from leakage at the vertical transected staple line of the stomach. CONCLUSIONS The use of unidirectional barbed sutures for running enterotomy closure after linear stapled RYGB is feasible and safe. Significant time benefit was seen regarding the closure of the GJA. Fewer additional stitches were necessary and postoperative intraluminal bleeding was less encountered.
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Affiliation(s)
- Ben Gys
- J-.B. Stessensstraat 2, B-2440, Geel, Belgium.
| | - Tobie Gys
- J-.B. Stessensstraat 2, B-2440, Geel, Belgium
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Shorter overall operative time when barbed suture is used in primary laparoscopic gastric bypass: A cohort study of 25,006 cases. Surg Obes Relat Dis 2017; 13:1484-1488. [PMID: 28732747 DOI: 10.1016/j.soard.2017.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/05/2017] [Accepted: 04/18/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Closing the remaining opening in a linear stapled anastomosis, for example in laparoscopic Roux-en-Y gastric bypass (LRYGB), can be challenging. OBJECTIVES To evaluate if the novel unidirectional barbed suture (BS) is of value in LRYGB compared with polyfilament (PS) suture. We have compared operative time, early complications, and length of stay, as well as anastomotic strictures and small bowel obstruction during the first year. SETTING Retrospective study from the Scandinavian Obesity Surgery Registry (SOReg). METHODS A nationwide cohort of 25,006 primary LRYGB (2211 BS and 22,795 PS) from SOReg were studied. No preoperative differences in age or gender were noted; however, BS patients had lower Body Mass Index (BMI) (41.3 versus 42.3 kg/m2, P<.001) and less diabetes (13.7% versus 15.4%, P = .03). RESULTS Total operative time was 11 minutes (16%) shorter using BS compared with PS (58 versus 69 minutes, P<.001), although the mesenteric openings were more frequently closed among BS patients (94% versus 71%, P<.001). No differences were seen in early complications; anastomotic leaks or intra-abdominal abscesses were noted in 1.8% and 1.4%, respectively, P = .17. The incidence of anastomotic strictures was similar (.13% versus .17%, P = .73) as was the incidence of surgery for small bowel obstruction (1.8% versus 1.6%, P = .69). CONCLUSIONS The use of barbed suture for closing the remaining opening in the gastrojejunostomy shortened the operative time without increasing the risk of complications. BS is still uncommon in LRYGB, but its implementation could have significant impact on operative time.
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Tsukada T, Kaji M, Kinoshita J, Shimizu K. Use of Barbed Sutures in Laparoscopic Gastrointestinal Single-Layer Sutures. JSLS 2017; 20:JSLS.2016.00023. [PMID: 27493467 PMCID: PMC4949351 DOI: 10.4293/jsls.2016.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background and Objectives: Laparoscopic anastomotic methods are not commonly used because of the cumbersome laparoscopic intracorporeal sutures and tying involved. The barbed suture is one of the various devices developed to simplify the placement of intracorporeal sutures. However, barbed sutures are not commonly used during reconstruction after radical gastrectomy in cancer patients or for single-layer entire-thickness running suturing for intestinal anastomoses. We describe the procedure for using barbed sutures and report on the short-term surgical outcomes. Methods: Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection. Results: In total, 38 patients underwent 40 laparoscopic anastomoses (esophagojejunostomies, 26; gastrojejunostomies, 7; and simple closure of gastric defect, 7); no cases required conversion to open surgery. Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect). Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use. No postoperative complications at the anastomosis site and no surgery-related deaths were noted. Conclusion: Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases.
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Affiliation(s)
- Tomoya Tsukada
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Masahide Kaji
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Jun Kinoshita
- Department of Gastroenterologic Surgery, Kanazawa University, Department of Gastroenterologic Surgery, Kanazawa University, Ishikawa, Japan
| | - Koichi Shimizu
- Department of Surgery, Toyama Prefectural Central Hospital, Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
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Genser L, Torcivia A, Helmy N, Vaillant J, Siksik J. Laparoscopic Roux-en-Y gastric bypass with hand-sewn gastro-jejunostomy. J Visc Surg 2017; 154:37-45. [DOI: 10.1016/j.jviscsurg.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Nakano T, Sato C, Sakurai T, Kamiya K, Kamei T, Ohuchi N. Thoracoscopic esophageal repair with barbed suture material in a case of Boerhaave's syndrome. J Thorac Dis 2016; 8:E1576-E1580. [PMID: 28149585 DOI: 10.21037/jtd.2016.12.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 53-year-old man was referred to our hospital with Boerhaave's syndrome. Thirty hours after onset, a left thoracoscopic operation was performed, with carbon dioxide pneumothorax and the patient in right semi-prone position. The thoracic cavity was copiously irrigated with physiological saline and a 4-cm longitudinal rupture was identified on the left side of the lower esophagus. The esophageal injury was repaired in 2 layers by using barbed absorbable suture material. The patient was allowed oral feeds after contrast esophagography confirmed the absence of contrast leak at the sutured site on postoperative day 7, and discharged by day 28. Suturing of the ruptured esophagus under thoracoscopic guidance is considered to be difficult and requires expertise. This case report demonstrates that the use of a barbed suture material simplifies thoracoscopic esophageal repair and also highlights the importance of pneumothorax and patient position in improving access to the esophagus.
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Affiliation(s)
- Toru Nakano
- Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Chiaki Sato
- Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Tadashi Sakurai
- Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Kurodo Kamiya
- Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Takashi Kamei
- Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
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Díaz-Güemes Martín-Portugués I, Maria Matos-Azevedo A, Enciso Sanz S, Sánchez-Margallo FM. Laparoscopic Cholecystoduodenostomy in Dogs: Canine Cadaver Feasibility Study. Vet Surg 2016; 45:O34-O40. [PMID: 27380956 DOI: 10.1111/vsu.12507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the feasibility of laparoscopic cholecystoduodenostomy in canine cadavers using barbed self-locking sutures. STUDY DESIGN In vivo experimental study. ANIMALS Fresh male Beagle cadavers (n=5). METHODS Surgery was performed by a single veterinary surgeon. Dogs were placed in dorsal recumbency and 15° reverse Trendelenburg position. The surgical procedure was performed with four 5 mm entry ports and a 5 mm 30° telescope. The cholecystoduodenostomy technique included dissection, incision of the gallbladder, and lavage, followed by gallbladder transposition over the duodenum, incision of the duodenum, and anastomosis. The latter was performed with a 4-0 barbed self-locking suture (V-Loc® 180). Subsequently, a leak test was performed by submerging the anastomosis in saline and insufflating air into the duodenum through a catheter. Total operative time and completion times for each procedural step were recorded. RESULTS The median total operative time was 151 minutes (range, 129-159). One conversion to open surgery occurred because of vascular hemorrhage. The 3 longest intraoperative steps were posterior wall anastomosis, gallbladder dissection, and anterior wall anastomosis. Intraoperative anastomotic leakage sites were identified in 3 of 5 dogs. Leaks were managed by placement of a single reinforcing conventional intracorporeal suture, which was adequate to obtain a watertight anastomosis. CONCLUSION This technique cannot be recommended in clinical practice until further studies are performed and the technique is further refined.
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Ferrer-Márquez M, Belda-Lozano R, Soriano-Maldonado A. Use of Barbed Sutures in Bariatric Surgery. Review of the Literature. Obes Surg 2016; 26:1964-9. [PMID: 27312347 DOI: 10.1007/s11695-016-2263-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Performing intracorporeal anastomoses and sutures is possibly the technique that requires the greater skill in laparoscopy. The emergence of new barbed sutures seems to facilitate the practice, with bariatric surgery (mainly in mixed and malabsorptive techniques) being one of the specialties that can most benefit from them. This review aims to evaluate barbed sutures' use and safety in bariatric surgery. Barbed sutures might facilitate the practice by improving some aspects of surgery such as reproducibility and operative time, although further research is needed.
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Affiliation(s)
- Manuel Ferrer-Márquez
- Department of Bariatric Surgery, Torrecárdenas Hospital, Almería, Spain. .,Department of General Surgery, Torrecárdenas Hospital, Almería, Spain.
| | - Ricardo Belda-Lozano
- Department of Bariatric Surgery, Torrecárdenas Hospital, Almería, Spain.,Department of General Surgery, Torrecárdenas Hospital, Almería, Spain
| | - Alberto Soriano-Maldonado
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
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Fernandez LC, Toriz A, Hernandez J, Sanchez N, Linares E, Zenteno M, Cuendis A, Olivares J, Guerrero G, Cervantes CF. Knotless choledochorraphy with barbed suture, safe and feasible. Surg Endosc 2015; 30:3630-5. [PMID: 26541731 DOI: 10.1007/s00464-015-4620-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the safety and feasibility of a running continuous unidirectional barbed suture (V-Loc, Covidien, Mansfield, MA) for primary common bile duct closure while performing laparoscopic common bile duct exploration (LCBDE). INTRODUCTION LCBDE is nowadays the best approach for treating complex common bile duct lithiasis or cases where the endoscopic retrograde cholangiopancreatography has failed. It is clear that the primary closure of the common bile duct must be preferred over the T-tube drainage. The actual technical aspects offer room for improvement. We present our experience with barbed suture, for which recently, various fields of surgery have become interested in and which now has a series of studies that support it for several uses. METHODS Between July 2012 and July 2014, 54 consecutive patients with bile duct stones underwent LCBDE by a single surgeon. Perioperative outcomes and 30-day complications were recorded. RESULTS Upon the completion of the exploration, 50 patients had primary common bile duct closure using knotless unidirectional barbed 3-0 V-Loc 90 suture, and 4 patients were excluded. All of the sutures were performed without knot tying. The procedure in all patients was successfully performed with no intraoperative complications. There were no bile leaks in the 50 patients or other postoperative complications such as infection, need for reintervention or death. CONCLUSION The use of unidirectional knotless barbed suture (V-Loc 90) is safe, feasible and effective on LCBDE for primary common bile duct closure. The biliary leak rate is acceptably low and comparable to the rate reported in the literature. This report is our initial experience that needs further clinical trials.
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Affiliation(s)
- Luis C Fernandez
- Hospital General Zona Norte, Puebla, Mexico. .,Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico.
| | - Augusto Toriz
- Hospital General Zona Norte, Puebla, Mexico.,Hospital General ISSSTE, Puebla, Mexico
| | | | | | | | | | - Adolfo Cuendis
- Hospital General "Dr. Manuel Gea Gonzalez", Mexico City, Mexico
| | | | | | - Cesar F Cervantes
- Hospital General ISSSTE, Puebla, Mexico.,Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico
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Giampaolino P, De Rosa N, Tommaselli GA, Santangelo F, Nappi C, Sansone A, Bifulco G. Comparison of bidirectional barbed suture Stratafix and conventional suture with intracorporeal knots in laparoscopic myomectomy by office transvaginal hydrolaparoscopic follow-up: a preliminary report. Eur J Obstet Gynecol Reprod Biol 2015; 195:146-150. [PMID: 26540594 DOI: 10.1016/j.ejogrb.2015.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/27/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare surgical outcomes of different types of intracorporeal sutures for laparoscopic posterior myomectomy, by a prospective randomized study. STUDY DESIGN Prospective randomized study on 47 patients with single posterior intramural myoma (4-7cm in diameter) undergoing laparoscopic myomectomy. The patients enrolled were divided into two groups, one operated using conventional suture in double strand, and the other with bidirectional barbed suture Stratafix. The main outcome measures were suturing time, peri-operative variables, and post-operative adhesions in both groups. RESULTS The mean operative time was shorter with the Stratafix™ than with the conventional suture (66.3±8.2 vs. 73±8min; p=0.005). Suturing time was significantly shorter in the Stratafix™ than in the control group (8.8±2.4 vs. 15.5±2.8min; p=0.001). Intraoperative bleeding was significantly less in the Stratafix group (p=0.0012). Conversely, there was no statistically significant difference for postoperative adhesions between the two groups (26.7% vs. 21.4% p=0.5). CONCLUSIONS The use of barbed suture may reduce operative time, suturing time, and blood loss. No difference in post operative adhesions was found.
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Affiliation(s)
| | - Nicoletta De Rosa
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | | | - Fabrizia Santangelo
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Carmine Nappi
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Anna Sansone
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
| | - Giuseppe Bifulco
- Department of Obstetrics and Gynaecology, "Federico II" University, Naples, Italy
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The Hand-sewn Anastomosis with an Absorbable Bidirectional Monofilament Barbed Suture Stratafix® During Laparoscopic One Anastomosis Loop Gastric Bypass. Retrospective Study in 50 Patients. Obes Surg 2015; 25:2457-60. [DOI: 10.1007/s11695-015-1921-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ferrer-Márquez M, Belda-Lozano R. Barbed sutures in general and digestive surgery. Review. Cir Esp 2015; 94:65-9. [PMID: 25890443 DOI: 10.1016/j.ciresp.2015.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/03/2015] [Accepted: 03/08/2015] [Indexed: 12/18/2022]
Abstract
The appearance of new barbed sutures is an advance in making knots and anastomosis, mainly in laparoscopic surgery, where the majority of the surgeons find themselves limited dealing with these sutures. Through this review we aim to evaluate both the use and the safety of the sutures in General and Laparoscopic Surgery. Barbed sutures seem to ease the procedures improving key aspects such as reproducibility and operative time.
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Affiliation(s)
- Manuel Ferrer-Márquez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Torrecárdenas, Almería, España.
| | - Ricardo Belda-Lozano
- Servicio de Cirugía General y Aparato Digestivo, Hospital Torrecárdenas, Almería, España
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Totally hand-sewn anastomosis using barbed suture device during laparoscopic gastric bypass in obese. A feasibility study and preliminary results. Int J Surg 2014; 12:1385-9. [DOI: 10.1016/j.ijsu.2014.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/17/2014] [Accepted: 10/25/2014] [Indexed: 11/18/2022]
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Kassir R, Gugenheim J, Blanc P, Tiffet O, Lointier P, Berger JL, Debs T, Amor IB, Iannelli A. The hand-sewn gastrojejunostomy: braided suture or monofilament suture? Obes Surg 2014; 25:545-6. [PMID: 25308114 DOI: 10.1007/s11695-014-1453-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Radwan Kassir
- Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France,
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Köhler G, Mayer F, Lechner M, Bittner R. Small bowel obstruction after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report and review of the literature. Hernia 2014; 19:389-94. [PMID: 25112384 DOI: 10.1007/s10029-014-1301-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Transabdominal preperitoneal hernioplasty (TAPP) is a common procedure for groin hernia repair in adults. The peritoneal closure after mesh placement can be performed in various ways. In any case, thorough closure is recommended to avoid mesh exposure to the viscera with the risk of adhesions and bowel incarceration into peritoneal defects. Postoperative intestinal obstructions can mainly occur due to adhesions or bowel herniation through peritoneal defects into the dissected preperitoneal space. Incarcerations can also occur as a consequence of trocar site herniation. RESULTS AND CONCLUSION Recently barbed self-anchoring knotless suturing devices are frequently used for peritoneal closure. The correct handling of such sutures is crucial to avoid potential complications. Despite of accurate management, bowel adherence and injuries or volvulus can occur. METHODS We present an unusual case of a postoperative small bowel obstruction owing to strained adhesions and ingrowth between a small bowel segment and a polyglyconate unidirectional self-anchoring barbed suture device. Medline and PudMed databases were searched using the below-mentioned keywords and the literature on efficacy and safety of barbed sutures for peritoneal closure is reviewed as well as the usage of such devices in other fields of surgery.
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Affiliation(s)
- G Köhler
- Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria,
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Palmisano S, Giuricin M, Casagranda B, de Manzini N. Zero frequency of internal hernias after laparoscopic double loop gastric bypass without closure of mesenteric defects. Surg Today 2014; 44:1920-4. [PMID: 24809335 DOI: 10.1007/s00595-014-0916-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/23/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Laparoscopic Roux-en-Y gastric bypass is among the most effective surgical procedures for morbid obesity; however, one of its most common long-term complications is internal hernia. The purpose of this study was to evaluate the incidence of internal hernia in patients undergoing a new gastric bypass surgical technique known as "double loop" without closure of the mesenteric defects. METHODS We reviewed 44 patients with morbid obesity, who underwent laparoscopic double loop gastric bypass. There were 34 women and 10 men, followed up for a mean period of 18 ± 3 months, mainly by periodic medical examinations and blood tests. RESULTS The initial body mass index (BMI) was 44.23 ± 4.7 and the mean % excess weight (%EW) was 105.83 ± 24.41. After 18 postoperative months, the mean BMI was 29.68 ± 3.7 kg/m(2), representing a mean loss of 14.5 BMI units, with the mean % excess weight loss (%EWL) of 64.33 ± 13.47. No cases of internal hernia were recorded. CONCLUSIONS Laparoscopic double loop gastric bypass without closure of the mesenteric defects is a safe and feasible procedure. A longer observational follow-up and a large number of patients are required to confirm significant results.
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Affiliation(s)
- Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy,
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Kassir R, Breton C, Lointier P, Blanc P. Laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunostomy using an absorbable bidirectional monofilament barbed suture: Review of the literature and illustrative case video. Surg Obes Relat Dis 2014; 10:560-1. [DOI: 10.1016/j.soard.2014.01.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 01/23/2014] [Accepted: 01/25/2014] [Indexed: 11/29/2022]
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Milone M, Di Minno MND, Galloro G, Maietta P, Bianco P, Milone F, Musella M. Safety and efficacy of barbed suture for gastrointestinal suture: a prospective and randomized study on obese patients undergoing gastric bypass. J Laparoendosc Adv Surg Tech A 2013; 23:756-759. [PMID: 23859743 DOI: 10.1089/lap.2013.0030] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Laparoscopic intracorporeal suturing and knot tying for anastomosis are considered the most difficult laparoscopic skills to master. The aim of this study was to establish the safety and efficacy of barbed suture for intestinal sutures to close the gastrojejunal anastomosis in obese patients undergoing gastric bypass. STUDY DESIGN All consecutive patients undergoing gastric bypass were screened for enrollment in our study. Patients were randomly allocated to undergo knotless anastomosis with barbed suture (V-Loc™ 180; Covidien, Mansfield, MA) (case group) or knot-tying anastomosis with 3/0 polyglactin sutures (Polysorb(®); Covidien) (control group). The primary outcome was the time needed for the gastrojejunal anastomosis and the operative time. The secondary outcomes were the incidence of leak, bleeding, and stenosis and the evaluation of the cost of the different procedures evaluated. RESULTS Among the 60 consecutive patients enrolled in our study, 30 underwent knot-tying anastomosis, and 30 underwent knotless anastomosis. The time needed for the anastomosis was significantly less (P<.001) in the knotless group, whereas no significant differences were found between the two groups for operative time (P=.151). We recorded one leak in the control group and one leak in the case group (P=1.000). One bleeding in the case group (P=1.000) and no stenosis in either group was recorded. Finally, in our experience, the knotless anastomosis was cheaper than the knot-tying anastomosis (P<.001). CONCLUSIONS Our study appears to be encouraging to suggest the use of barbed suture for gastrointestinal anastomosis.
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Affiliation(s)
- Marco Milone
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy.
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Arru L, Azagra JS, Goergen M, Legrand A, Orlando GG, Poulain V. Percutaneous and Reduced-Port Roux-en-Y Gastric Bypass: Technical Aspects. J Am Coll Surg 2013; 217:e1-8. [DOI: 10.1016/j.jamcollsurg.2013.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/16/2013] [Accepted: 04/09/2013] [Indexed: 11/26/2022]
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Barbed unidirectional V-Loc 180 suture in laparoscopic Roux-en-Y gastric bypass: a study comparing unidirectional barbed monofilament and multifilament absorbable suture. Surg Endosc 2013; 27:3846-51. [PMID: 23722892 DOI: 10.1007/s00464-013-2993-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed primarily to evaluate the safety of digestive running suture (in gastrojejunal and antecolic jejunojejunal anastomosis closure) using unidirectional absorbable barbed suture (V-Loc 180) in laparoscopic Roux-en-Y gastric bypass (LRYGB) and secondarily to assess the efficacy of V-Loc 180 in reducing operative time. METHODS A prospective cohort study of 315 consecutive patients who underwent LRYGB was performed between October 2009 and October 2012 using an identical procedure technique. For the first 76 patients, a multifilament absorbable suture was used to assess the gastrojejunal anastomosis and the antecolic jejunal suture. For the following 239 patients, a unidirectional barbed monofilament suture was used. Data including operative time, time required for gastric pouch creation, time spent in both anastomoses constructions, conversion rate, and complications were prospectively recorded. RESULTS The postoperative complications did not differ significantly between the two groups. Early complications were observed for 1 patient (1.3%) in the multifilament group and for 14 patients (5.8%) in the barbed procedure group (p > 0.05). Late complications were observed for 1 patient (1.3%) in the multifilament group and for 5 patients (2%) in the barbed procedure group (p > 0.05). A shortened operative time was achieved in the barbed suture group. The mean operative time was 74.3 ± 15.3 min in the Vicryl group versus 62.7 ± 15.5 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the gastrojejunal anastomosis was 21.3 ± 6.3 min in the Vicryl group versus 17.4 ± 5.1 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the jejunojejunal anastomosis was 21.4 ± 4.9 min in the Vicryl group versus 15.2 ± 5.5 min in the V-Loc group (p < 0.05). CONCLUSIONS The authors' experience has demonstrated that the use of interlocked V-Loc suture during LRYGB anastomosis appears to be safe and efficient. The findings show a shortened total operative time in terms of single gastrojejunal or jejunojejunal anastomosis time. No statistically significant differences in early or late postoperative complications were observed between the V-Loc and multifilament absorbable suture patients.
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Facy O, De Blasi V, Goergen M, Arru L, De Magistris L, Azagra JS. Laparoscopic gastrointestinal anastomoses using knotless barbed sutures are safe and reproducible: a single-center experience with 201 patients. Surg Endosc 2013; 27:3841-5. [PMID: 23670743 DOI: 10.1007/s00464-013-2992-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/18/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Intestinal anastomosis is a complex procedure during laparoscopy, mainly due to the difficulties knotting the sutures. Unidirectional barbed sutures have been proposed to simplify wall and mesentery closure, but the results for intestinal anastomosis are not clear. This study aimed to establish the feasibility and the safety of laparoscopic intestinal anastomosis using barbed suture. METHODS Between June 2011 and May 2012, 15-cm-long unidirectional absorbable barbed sutures (V-Loc; Covidien, Mansfield, MA, USA) were used for all laparoscopic intestinal anastomoses: one suture for closure of intestinal openings after mechanical anastomoses and two sutures for hand-sewn anastomoses. RESULTS Over a 1-year period, 201 consecutive patients required 220 laparoscopic anastomoses for gastrojejunostomy (n = 177; 172 during Roux-en-Y gastric bypass and 5 after gastrectomy), ileocolostomy (n = 15), colocolostomy (n = 1), esophagojejunostomy (n = 5), and jejunojejunostomy (n = 22; 4 after small bowel resection and 18 during gastric bypass or gastrectomy). Senior and training surgeons performed 209 closures of intestinal openings and 11 hand-sewn anastomoses. There was no conversion to usual sutures. One fistula occurred in an esophagojejunostomy and was managed conservatively. One self-limited anastomotic bleeding occurred, and no anastomotic stenosis occurred during 6 months of follow-up evaluation. CONCLUSIONS The use of knotless barbed suture for laparoscopic intestinal anastomosis is safe and reproducible.
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Affiliation(s)
- Olivier Facy
- Department of Digestive Surgery, University Hospital of Luxembourg, Luxembourg, Luxembourg,
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