Absorbable Barbed Suture Research Articles

Wound Management following Total Knee Arthroplasty: An Updated Review.

Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.

460 Alianza Barbed Pharyngoplasty in Moderate to Severe OSAS Patients

Abstract Introduction Alianza barbed pharyngoplasty is a recent non-resective surgical tecnique, indicated for patients with obstructive sleep apnea syndrome (OSAS) with circular retropalatal obstruction pattern. It has the aim of stabilizing and reducing the collapsibility of the palato-pharyingeal area during sleep. It uses barbed absorbable sutures that allow to suspend palato-pharyngeal structures to anatomical non-collapsable landmarks (posterior nasal spine, pterigoideal hamulus, pterigomandibular raphe). The aim of this study is to evaluate efficacy and safety of Alianza barbed pharyngoplasty in moderate to severe OSAS. Methods Thirty-six consecutive patients with moderate to severe OSAS underwent Alianza barbed pharyngoplasty. Preoperatively all patients presented with palatal hypertrophy, concentric collapse and retropalatal flatter during drug induced sleep endoscopy (DISE) and did not tolerate CPAP and/or MAD therapies. All patients underwent clinical examination, polysomnography, and subjective evaluation of snoring with visual analogue scale (VAS) and Epworth Sleepiness Scale (ESS) both pre-operatively (T0) and at 6 months postoperatively (T1). Results There was a significant reduction of AHI at T1, from 32.49 ± 14.55 to 12.1 ± 12.16 (p< 0.05) of AHI. Mean AHI gain was of 20.39 ± 11.58, in particular 13.34 ± 5.48 in moderate OSAS patients and 30.18 ± 9.34 in severe OSAS patients. There was also a significant ODI reduction, from 27.57 ± 15.68 to 12.97 ± 13.25 (p< 0.05). There was a significant reduction of ESS, from 8.75 ± 4.51 to 4.05 ± 2.39 (p< 0.05) and a significant reduction of snoring VAS from 7.85 ± 1.23 to 3.2 ± 1.7 (p< 0.05). Conclusion Alianza barbed pharyngoplasty led to significant improvement both in objective parameters measured with polysomnography (AHI and ODI), and in subjective parameters (ESS and snoring VAS) in moderate to severe OSAS patients. Support (if any):

3D Laparoscopic common bile duct exploration with primary repair by absorbable barbed suture is safe and feasible

Endoscopic retrograde cholangiopancreatography (ERCP), with interval laparoscopic cholecystectomy (LC), is the most common treatment approach for common bile duct (CBD) stones. However, recent studies show that single-stage laparoscopic CBD exploration (LCBDE) is safe and feasible. Three-dimensional (3D) laparoscopy enhances depth perception and facilitates intracorporeal suturing. The application of 3D technology for LCBDE is emerging, and we report our case series of 3D LCBDE. We audited the 27 consecutive 3D LCBDE performed from July 2017 to January 2020. We have a liberal policy for magnetic resonance cholangiopancreatography (MRCP) in patients with deranged liver function tests (LFT). All CBD explorations were done through choledochotomy with a 5 mm flexible choledochoscope and primarily repaired with an absorbable barbed suture without a stent or T-tube. The mean age of patients was 68 (range 44-91) years, and 12 (44%) were male. The indications for surgery were choledocholithiasis 67% (n=18), cholangitis 22% (n=6), and gallstone pancreatitis 11% (n=3). About 67% (n=18) had pre-operative ERCP. About 37% (n=10) had pre-operative biliary stent. Pre-operative MRCP was done in 74% (n=20), and the mean diameter of CBD was 14.5 mm (range 7-30). The median operative time was 160 (range 80-265) min. The operative drain was inserted in 18 patients. One patient each (4%) had a bile leak and a retained stone. There was no open conversion, readmission, or mortality. 3D LCBDE with primary repair by an absorbable barbed suture is safe and feasible. This paper emphasized that one stage LCBDE should be a treatment option which is comparable with two stage ERCP followed by LC to treat CBD stones. In addition, 3D technology and barbed sutures use in LCBDE are safe and useful.

Adjuvant botulinum toxin for endoscopic management (preaponeurotic endoscopic repair) of severe diastasis recti

INTRODUCTION: Diastasis recti (DR) associated with midline hernias is common. Big size DR represents a clinical and cosmetic problem. Its repair is challenging, with intraoperative and postoperative risks. The adjuvant of botulinum toxin serotype A makes it possible to restoration of the linea alba by preaponeurotic endoscopic repair (REPA).METHODS: This was a retrospective study with prospective database. Between February 2019 and July 2020, six women were operated, with a mean age of 39 years and a diagnosis of DR >80 mm, with a body mass index of 27. All patients were infiltrated with 50 UR of botulinum toxin serotype A on each side, 30 days before the surgery.RESULTS: The intraoperative diagnosis of DR was 87.5 mm average, associated with midline hernias in 100%, with a mean transverse diameter of 24 mm (10–60 mm) Anatomical restoration of the linea alba was performed with a slow absorbable barbed suture. The wall was reinforced with 100% macroporous polypropylene mesh, with 83.3% atraumatic fixation and 16.6% absorbable traumatic fixation. The surgical time was 94 ± 15 min. Postoperative pain was 2/10 ± 1 according to the Visual Analog Scale, allowing a hospital stay of 18 ± 4 h. Return to work 18 ± 3 days. The mean follow-up was 9 (2–18) months by the clinical and ultrasound examination in 100%, without complications or recurrences.CONCLUSIONS: The application of botulinum toxin serotype A associated with endoscopic repair (REPA) allowed solving the big size DR and midline hernias with suture of the rectus sheath with less tension, associated with a reinforcement prosthesis, allowing a reduced hospitalization with a low level of postoperative pain, avoiding muscle release incisions, which are irreversible and not exempt from morbidity, added to the proven benefits of endoscopic access.

Closure of Choledochotomy With a Barbed Absorbable Suture After Laparoscopic Common Bile Duct Exploration.

Closure of Choledochotomy With a Barbed Absorbable Suture After Laparoscopic Common Bile Duct Exploration.

Laparoscopic Radical Hysterectomy with Enclosed Colpotomy Using Surgical Stapler for Early-Stage Cervical Cancer

Study Objective To report the application of Ethicon Endo-Surgery re-usable linear cutter (Ethicon endocutter) in vaginal closure without usage of uterine manipulator to prevent tumor spillage in laparoscopic radical hysterectomy for early-stage cervical cancer. Design A step-by-step explanation of the procedures using a video. Setting Hospital for women's health teaching and research. Patients or Participants This is a 41-year-old woman with clinical stage IBI cervical squamous cell cancer. Interventions After the contraindication was removed, laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition were performed, the surgery was finished without usage of uterine manipulator. The patient signed an informed consent that allows us to use her clinical data. Measurements and Main Results In this method, after completion of the radical hysterectomy procedures, an Ethicon endocutter was placed into abdominal cavity through a 12-mm trocar. The uterus was elevated with fixed sutures on the uterus. Then, the stapler was placed. Before the surgical stapler was fired to close the vagina, we should checked that no other unintended structure was included in the jaws of the stapler. After being fired, the stapler places 2 triple-staggered rows of titanium staples and simultaneously knife blade cuts between them. Once the vagina has been divided, the stapler was released. The upper part of the vaginal cuff was excised and checked by pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with absorbable barbed sutures. Conclusion Vaginal closure with Ethicon endocutter before colpotomy is a useful and effective procedure to block vaginal cuff and prevent tumor spillage during laparoscopic radical hysterectomy of cervical cancer.

Robotic Port Closure: An Efficient, Safe, Novel Technique for Fascial Suturing

Study Objective Minilaparotomy can be closed effectively with an intra-abdominal, robotic-assisted technique. Design N/A Setting With adoption of more laparoscopic and robotic techniques for surgical procedures, there has been a rise in the use of minilaparotomy incisions for tissue extraction. Fascial closure can be accomplished by a variety of approaches. The traditional and most common approach is approximating the fascial edges under direct vision, however, in the obese patient these incisions may be quite challenging to close in this fashion. There have been multiple instruments described for port site fascial closure ( Patients or Participants This is a 60-year-old female who presented for surgical management of stage IV pelvic organ prolapse. The patient underwent a robotic-assisted supracervical hysterectomy, bilateral salpingo-oophorectomy, and sacrocolpopexy. Interventions After extraction of the specimen, the extraction site is sealed to maintain pneumoperitoneum using any of a variety of options such as clamps, staples, tapes, or sutures. Once the pneumoperitoneum is maintained, the fascial edges are identified and freed from the overlying peritoneum. The fascial edges are then approximated with a running delayed absorbable barbed suture and then the peritoneum is closed with 2-0 delayed absorbable barbed suture to cover the fascial closure and reduce adhesions to the site. Measurements and Main Results This technique provides excellentexposure and visibility of the fascial edges regardless of a patients' body habitus. We believe this is a safe and feasible technique that provides an easy, quick alternative to the traditional direct fascial closure technique. Conclusion Robotic-assisted intra-abdominal fascial closure is efficient and safe. With proper closure of the abdominal wall fascia at these small and difficult incision sites, including minilaparotomy, we may be able to reduce the risks of immediate and delayed incisional hernia.

Bidirectional knotless barbed versus conventional smooth suture for closure of surgical wounds in inguinal castration in horses

BackgroundCastration of the stallion is one of the most frequently performed surgical procedures in the horse. Recently barbed suture materials for surgical wound closure were introduced to the market with manufacturers claiming that these sutures enhance speed and security as they eliminate the need to tie knots. Recently, it has been suggested that this type of suture may increase postoperative complications. This study aimed at investigating and comparing a bidirectional absorbable knotless barbed suture (KBS) to a conventional smooth suture (SS) for wound closure of inguinal castrations in the horse. This was done by evaluating short-term and post-discharge complications and by comparing the time spent on suturing the surgical wounds after bilateral inguinal castration, which was performed on 45 horses undergoing castration at The Large Animal Teaching Hospital at University of Copenhagen from September 2017 to May 2019.ResultsShort-term complications were few; at 24 h minor swelling occurred in 29 and 33% of horses sutured with KBS and SS respectively and cutaneous dehiscence during recovery occurred in two horses of each group. Post-discharge follow-up revealed that three horses needed veterinary attention for treatment of complications (scrotal swelling (n = 1, KBS); wound exudation (n = 1, SS) and wound dehiscence after return to pasture (n = 1, SS)). Wound closure was achieved 6 min faster with KBS than with SS (P < 0.0001).ConclusionsUse of the KBS suture did not result in increased occurrence of postoperative complications. Wound closure was faster with KBS than with SS in equine bilateral inguinal castration. Our results show that KBS can safely be used in the horse following bilateral inguinal castrations without adverse effects and with a reduction in suturing time.

Rigging the nose: a pilot study using barbed sutures in patients with deviated nose

BackgroundA deviated nose is a very common developmental feature in Caucasian populations and represents a frequent indication for rhinoplasty, either functional or esthetic. We aim to assess the pattern of nasal axis stabilization after rhinoplasty in the deviated nose on the basis of anthropometric measurements: median face axis (MFA), interpupillary meridian axis (IMA), and scoliosis angle (SA); to study possible effects of rigging the nose in the midfacial soft tissues using absorbable soft sutures; to investigate possible side effects.MethodsSeventy patients with a non-traumatic deviated nose (n = 50 as control group, n = 20 as treated group with placement of barbed suture in the midfacial soft tissues) underwent rhinoplasty procedures. We retrospectively examined the pattern of deviation recurrence over time in a consecutive series of 70 non-traumatic patients undergoing primary esthetic or functional rhinoplasty (n = 50 as control group, n = 20 as treated group with placement of barbed suture in the midfacial soft tissues). Patients were followed up at 1 week, 2 weeks, 1 month, 3 months, and 1 year postoperatively.ResultsNinety-three percent (65/70) of the patients had an asymmetric face after comparing the two anthropometric angles MFA and IMA. Overcorrection of NA at one week postoperatively was observed in 1.25% and 35.7% of patients in the control and treated groups, respectively (p = 0.006). MFA shifted from 4.16° ± 3.1° preoperatively to 1.2° ± 1.4° at 1 week, 1.0° ± 1.1° at 2 weeks, 1.1° ± 1.4° at 1 month, 1.1° ± 1.5° at 3 months, and 1.7° ± 2° at 1 year in the control group. In the treated group, MFA shifted from 5.7° ± 2.9 preoperatively to − 0.34° ± 2.9° at 1 week, 1.0° ± 1.1° at 2 weeks, 0.59° ± 0.96° at 1 month, 1.22° ± 0.83° at 3 months, and 1.63° ± 0.8° at 1 year. Differences between the groups were significant at 1 week (p = 0.02), but differences were not significant at 2 weeks, 1 month, 3 months, and 1 year.ConclusionsThis pilot study demonstrates that the progressive re-deviation pattern is altered during the first weeks after surgery in the barbed sutures group. Absorbable barbed sutures in facial soft tissues are well tolerated. Longer lasting sutures may help to obtain definite advantage.Level of evidence: Level IV, therapeutic study.

Laparoscopic pancreaticojejunal anastomosis using knotless barbed absorbable sutures are simple, safe and effective: an experience with 34 procedures

Background: The aim of our article is to present the technique of laparoscopic pancreaticojejunostomy that is currently used in our center.

Reinforcing Anastomotic Stoma by Suturing with Laparoscopy Results in Anastomotic Atresia

Here we describe and share an interesting complication and the management of left-sided colostomy stoma closure using knotless barbed absorbable suture. Inadvertently one of the sutures picked and engaged the opposite wall of the colon presenting as intestinal obstruction. Proximal to anastomotic site the dilated colon was visible on CT scan (Fig. 1). A fibre-optic colonoscopy was done, problem suspected and the offending suture that had closed shut the lumen was cut and the patient was relieved and made a complete recovery (Fig. 2).

Utilization of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles After Robotic Radical Prostatectomy and Bilateral Pelvic Lymph Node Dissection.

Introduction: The peritoneal interposition flap (PIF) has been shown to prevent postoperative symptomatic lymphocele (SL) formation after robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection (PLND). The PIF inhibits the mobilized bladder from resealing over its lateral dissection planes, which overly the lymphadenectomy beds. This creates a window for lymphatic fluid to drain into the peritoneal cavity where it can be absorbed. Herein, we externally validate its utility in preventing postoperative SL formation and assess its effect on postoperative urinary function. Materials and Methods: We retrospectively reviewed all consecutive patients who underwent RARP with bilateral PLND by a single surgeon between July 2016 and September 2019. All patients who underwent surgery before August 8, 2018 did not receive the PIF, while those who underwent surgery after August 8, 2018 received the PIF. Our PIF technique involves fixing the peritoneum overlying the lateral dome of the bladder to the ipsilateral, anterior-lateral surface of the bladder using a barbed absorbable suture. Continuous and categorical variables were compared between the two groups using independent t-tests and chi-square tests, respectively; p < 0.05 was considered significant. Results: Of 318 total patients, 201 did not undergo the PIF and 117 underwent the PIF. With regard to postoperative complications, patients undergoing the PIF had a lower incidence of SL compared with those not undergoing the PIF (0.0% vs 6.0%, p = 0.007). There was no difference in 30-day postoperative nonlymphocele complications (Clavien >2) between both groups (p = 0.800). With regard to urinary function, there was no difference in the rate of 3-month postoperative continence (p = 0.624), preoperative American Urological Association Symptom Score (AUASS) (p = 0.898), and postoperative AUASS (p = 0.470) between both groups. Conclusion: Utilization of a PIF may minimize the risk of SL formation after RARP and PLND without increasing the risk of non-SL-related complications. This technique does not adversely affect postoperative urinary function.

A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study.

This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD). EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates. 11 lesions were included. Median size of the mucosal defect was 38 mm (range 25 - 55 mm) and the lesion characteristics were as follows: lower rectum/upper rectum/ascending colon/cecum = 3/3/2/3, and 0-IIa/0-Is + IIa/others = 5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30 - 120 minutes) and median number of stitches was 8 (range 6 - 12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively. EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.

Additional Relaxing Suturing Using Absorbable Symmetric Barbed Sutures to Help Close Scalp Defects.

Summary:Closing a scalp wound with skin defects is challenging because the scalp skin lacks extensibility and closing it tends to result in a remarkable, widespread, hairless scar. Absorbable symmetric barbed suture device (Stratafix Symmetric; Ethicon, USA) allows wound closure using a pulling motion alone and provides a strong and secure closure for the high-tension area. We used this device to close wide scalp defects easily without tension and with minimized sequential scalp alopecia. The aim of this study was to show our experiences with using this technique. From January 2017 to March 2019, our relaxing suture technique was performed in 7 pediatric patients with scalp alopecia due to various lesions that ranged 23.0 ± 6.5 mm. After resecting the lesions, the galea was sutured using the 3-0 absorbable symmetric barbed suture via a running subcutaneous suture technique. The widespread wound edges were approximated by pulling the suture device. Wound closure was completed with galeal suturing and a superficial suture. We evaluated the width of the postoperative hairless scar at the final follow-up. In all 7 patients, we could approximate the widespread wound edges by pulling alone. Subsequently, the wounds could be closed without tension or difficulty. The mean width of the postoperative hairless scar was 3.3 ± 0.8 mm (range: 1.9–4.3 mm), and no complication was detected during the follow-up period. Our new relaxing suture technique using an absorbable barbed suture with symmetric anchors is a supportive and additional way to help close scalp defects.

Chest drains: purse string suture 4.0.

There are many discussions about the technique of removal of chest drains. In our hospital, we have used an intracutaneous suture technique with non-absorbable suture material for the purse-string suture for a few years now. Thus the cosmetic results improved considerably. Nevertheless, the thread has to be removed after 10-14days. To further improve patient comfort we developed a purse-string suture technique using an absorbable barbed suture. We noticed better cosmetic results and less painfull drain removal. Furthermore, there is no more need for a stitch removal which reduces material costs and also pain.

An Alternative Approach to Posterior Colporrhaphy Plication Using Delayed Absorbable Unidirectional Barbed Suture.

An Alternative Approach to Posterior Colporrhaphy Plication Using Delayed Absorbable Unidirectional Barbed Suture.

Robotic Assisted Laparoscopic Repair of Isthmocele

Video Objective This video demonstrates the technique for a Robotic assisted laparoscopic repair of a large Isthmocele. Setting A 41-year-old G1P1 woman presented with secondary infertility and postmenstrual spotting. Her first spontaneous pregnancy ended by cesarean section delivery 5 years ago. She has a 3 years history of secondary infertility and failed Intracytoplasmic sperm injection (ICSI). Transvaginal ultrasound showed a wedge-shaped hypoechoic area in the myometrium at the level of the previous cesarean scar and Pelvic MRI confirmed the diagnosis of Isthmocele. Interventions Diagnostic hysteroscopy done prior to the Robotic assisted Laparoscopy for endometrial cavity assessment and localization of the cesarean scar defect showed an endometrium studded with black hemosiderin-like lesions, biopsy was taken. Then a Robotic assisted Laparoscopic surgery started with dissection of the vesicovaginal plane and resection of the isthmocele pouch. Complete excision of fibrotic tissues performed and a Hegar dilator was placed to maintain cervico-uterine patency. The defect was then repaired in 3 layers. For the first two layers 0-polyglactin (Vicryl®) was used for faster absorption of the suture material in contact with the endometrial cavity. The third layer was closed using 2-0 delayed absorbable barbed sutures (V-LocTM). An adhesion barrier was placed overlying the suture line. The operative time was 150 minutes and the patient had an uneventful postoperative recovery. Conclusion The pathology of the endometrial biopsy showed the unusual finding of endometrial glands filled with blood.The postoperative vaginal ultrasound confirmed a well re-approximated uterine wall, a myometrial thickness of 14 mm and a continuous and intact endometrial lining at 6 weeks postoperatively. At 3 months a flexible office hysteroscopy showed excellent repair, complete healing of the lower uterine defect and a normal endometrial cavity with resolution of the abnormal lesions.Post-operatively, the patient denied any post-menstrual spotting and conceived spontaneously 4 months after the repair. This video demonstrates the technique for a Robotic assisted laparoscopic repair of a large Isthmocele. A 41-year-old G1P1 woman presented with secondary infertility and postmenstrual spotting. Her first spontaneous pregnancy ended by cesarean section delivery 5 years ago. She has a 3 years history of secondary infertility and failed Intracytoplasmic sperm injection (ICSI). Transvaginal ultrasound showed a wedge-shaped hypoechoic area in the myometrium at the level of the previous cesarean scar and Pelvic MRI confirmed the diagnosis of Isthmocele. Diagnostic hysteroscopy done prior to the Robotic assisted Laparoscopy for endometrial cavity assessment and localization of the cesarean scar defect showed an endometrium studded with black hemosiderin-like lesions, biopsy was taken. Then a Robotic assisted Laparoscopic surgery started with dissection of the vesicovaginal plane and resection of the isthmocele pouch. Complete excision of fibrotic tissues performed and a Hegar dilator was placed to maintain cervico-uterine patency. The defect was then repaired in 3 layers. For the first two layers 0-polyglactin (Vicryl®) was used for faster absorption of the suture material in contact with the endometrial cavity. The third layer was closed using 2-0 delayed absorbable barbed sutures (V-LocTM). An adhesion barrier was placed overlying the suture line. The operative time was 150 minutes and the patient had an uneventful postoperative recovery. The pathology of the endometrial biopsy showed the unusual finding of endometrial glands filled with blood.The postoperative vaginal ultrasound confirmed a well re-approximated uterine wall, a myometrial thickness of 14 mm and a continuous and intact endometrial lining at 6 weeks postoperatively. At 3 months a flexible office hysteroscopy showed excellent repair, complete healing of the lower uterine defect and a normal endometrial cavity with resolution of the abnormal lesions.Post-operatively, the patient denied any post-menstrual spotting and conceived spontaneously 4 months after the repair.

Robotic Essure® Coil Removal Via Cornual Wedge Resection

Video Objective Describe considerations for pre-operative surgical planning and identify techniques for a cornual wedge resection to adequately remove Essure® coils. Setting A premenopausal female with history of Essure® hysteroscopic sterilization with subsequent development of chronic pelvic pain desiring removal with a uterine sparing procedure. Interventions After confirmation of location and number of Essure® coils by pelvic ultrasound and X-ray, a robotic cornual wedge resection was performed using gentle traction-counter traction, sharp dissection and minimal electrosurgery to remove both fallopian tubes without exposure or fragmentation of the coils. The cornua was then closed with delayed absorbable barbed suture. Conclusion Adequate removal of Essure® coils involve proper pre-operative imaging and complete resection of the tubal interstitium with minimal coil exposure or fragmentation. This prevents breaking or incompletely removing the metallic coils and pro-inflammatory PET fibers.

In Vivo Comparison of MONOFIX, A Novel Barbed Suture with a Triangular Stopper, with Pre-existing Products in a Porcine Model

Study ObjectiveMONOFIX, a new absorbable barbed suture device, has a triangular stopper at the end to hold the suture to the tissue without hooking the looped end or knotting. The aim of this study was to compare the biomechanical strength and histologic features of MONOFIX with other barbed suture devices using a porcine model. DesignWell-designed, controlled trial without randomization. SettingAnimal laboratory in university hospital. SubjectsSixteen, 60-kg, mature female domestic pigs (skin closure group) and 5, 60-kg, mature female domestic pigs (fascial closure group). InterventionsIn the skin closure group, 3-0 MONOFIX versus 2 widely used 3-0 absorbable barbed sutures (3-0 V-Loc 180 or Stratafix). In the fascial closure group, 2-0 MONOFIX versus 1 widely used 2-0 absorbable barbed sutures (2-0 Stratafix). Measurements and Main ResultsIn the skin closure group, the biomechanical wound strength of skin sutured with size 3-0 MONOFIX, V-Loc 180, or Stratafix was evaluated by postoperative day assessment (days 0, 3, 7, 14, and 28). In the fascial closure group, pigs underwent 2 paramedian incisions and were sutured with 2-0 MONOFIX or with 2-0 Stratafix to evaluate histologic reaction. At 6 weeks the tissues around the suture line were excised and microscopically evaluated. The biomechanical strength of the MONOFIX had similar tissue tensile strength compared with the control, regardless of postoperative day. In the fascial closure model, there was no significant difference in the average tissue reaction score between MONOFIX and Stratafix (1.2 ± .3 vs 1.3 ± .3, p = .478). ConclusionThis study demonstrated that MONOFIX has equivalent tensile strength and histologic reaction when compared with commonly used barbed suture devices. Accordingly, this preclinical study suggests that the use of MONOFIX is a safe alternative to other barbed suture devices.

Peritoneal closure using self-anchoring-barbed absorbable sutures during laparoscopic transabdominal preperitoneal inguinal hernioplasty: How to make it more safe?

CONTEXT: Peritoneal closure with a barbed suture during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a controversial subject due to the risk of postoperative intestinal adhesions and occlusions formed by this type of suture. This risk, however, was only reported in several case reports. The purpose of this study is to determine the incidence of postoperative intestinal obstructions related to the use of barbed suture materials in laparoscopic hernia repair (TAPP). PATIENTS AND METHODS: We included all patients that underwent laparoscopic TAPP inguinal hernia repair between October 2012 and October 2017. All peritoneal closures were accomplished using absorbable barbed sutures. Operative data were collected in a dedicated database and analyzed retrospectively. RESULTS: Only 3 out of the 320 patients included (0.9%) presented with an early postoperative intestinal obstruction and required further surgery. Two of the three patients (0.6%) were found to have intestinal incarceration in the peritoneal defects initially created during the hernia repair. However, the last patient had an intestinal volvulus due to adhesions formed with the barbed suture. None of the patient characteristics collected were significant risk factors for developing postoperative intestinal obstructions. CONCLUSION: In this study, peritoneal closure using barbed suture material did not increase the risk of early postoperative intestinal obstruction, in comparison to other suture materials reported in the literature. The use of barbed absorbable sutures for peritoneal closure during laparoscopic TAPP seems to be safe when sutures are cut short and covered by the peritoneum.