Barbed Suture Material Research Articles

A Prospective Randomized Controlled Study of Stratafix versus Standard-of-Care for Deep Tissue Closure in Orthopedic Surgery.

Orthopedic deep surgical incisions require the approximation of 1 or multiple tissue layers. This prospective randomized controlled study aimed to assess the usefulness and effectiveness of a barbed suture technique (Stratafix symmetric PDS plus) versus the conventional interrupted knotted suture technique for deep tissue closure in orthopedic surgery by comparing deep fascia suture time, relative cost, and wound-related complications. A total of 254 patients with deep surgical incisions who underwent orthopedic surgery between October 1, 2020, and June 30, 2021, were recruited. Their general characteristics (age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status score, total operation time, and length of deep incision) and factors related to deep incision wounds (suture type and number, wound closure time, and operation site outcomes) were collected. The general characteristics did not differ between the Stratafix and conventional groups. There were no between-group differences observed in total operation time or total anesthesia time. The wound suture times differed significantly. In the conventional group, the suture time per unit length was lower in the group with the length of deep incision under 20 cm but did not differ significantly for each wound size. In the Stratafix group, the suture time per unit length was lower in the group under 15 cm, with the shortest time observed for 10-14.9 cm, followed by 5.0-9.9 cm and the group under 5 cm. The conventional group developed 4 cases of superficial wound infection or surgical wound necrosis. One case of protruded suture tap occurred in the Stratafix group. The average suture time per unit length increased for lengths under 5 cm as barbed sutures required more time from the start of the first suture to finish of the last suture. There was no significant benefit for very short suture length. One barbed suture material allows a suture of approximately 10-12 cm; sutures beyond that require more time because the surgeon has to start again. The Stratafix group used less suture material than the conventional group.

Immediate Effects of the Self-Retaining Barbed Suture Material Application 
 for Gastrojejunostomy During Mini Gastric Bypass Laparoscopic Surgery

Background. The safety of self-retaining barbed suture material application when closing wounds of hollow organs and forming anastomoses remains controversial. Data on the use of self-retaining barbed suture material at the stage of a single anastomosis formation during mini gastric bypass laparoscopic surgery (mini gastric bypass - MGB) in the treatment of morbid obesity is scarce and includes both examples of suturing a technological hole after the implementation of a hardware technique, and totally hand-sewn intracorporeal knotless formation of a gastrojejunostomy.The aim of the study was to evaluate the immediate effects of single-row continuous sutures performed with self-retaining barbed unidirectional suture material for intracorporeal hand-sewn gastrojejunostomy during MGB.Methods. The study included 116 patients with grade II-III obesity who underwent MGB. The total duration of operations and the duration of the gastrojejunostomy stage, the volume of intraoperative blood loss, the frequency and severity of intra- and postoperative complications were prospectively studied in accordance with the unified classifications of Satava-Kazaryan and Accordion, respectively. The first group consisted of 56 patients; a conventional synthetic (polydioxanone) monofilament suture material was used for hand-sewn gastrojejunostomy in patients of this group. The second group consisted of 60 patients; gastrojejunostomy was performed with single-needle unidirectional self-retaining barbed absorbable polyester monofilaments in patients of this group. The study groups did not differ significantly in demographic characteristics, body mass index (BMI), the nature of comorbid pathology and the frequency of previous operations.Results. The use of unidirectional self-retaining barbed suture material for a hand-sewn intracorporeal single-row gastrojejunostomy in MGB was accompanied by a significant reduction in the total duration of interventions due to a reduced gastrojejunostomy stage if compared with the use of conventional synthetic monofilaments. The median volume of blood loss during operations did not exceed 50 ml and had no significant differences between groups. Intraoperatively, in patients of the study groups there were registered only complications of the first degree of severity, according to the Satava-Kazaryan classification, with a frequency of 6.7-8.9% (p = 0.737). In the postoperative period, the development of minor complications (first severity of the Accordion system) occurred in 19.6% and 16.7% of patients of the first and second groups, respectively (p = 0.810). The duration of hospital stay was 3.0 (2.5; 3.0) and 2.7 (2.7; 3.0) days in the first and second groups, respectively (р=0,790).Conclusion. The achieved reduced duration of MGB due to the reduced stage of gastrojejunostomy with self-retaining barbed unidirectional suture material, and comparable immediate effects of surgical treatment in patients of the first and second groups demonstrate significant outcomes. Further study is necessary to investigate long-term effects of the knotless suture application for a single anastomosis formation during MGB surgery.

Simple technique of double-layer enterotomy closure using a bidirectional barbed suture material when performing intracorporeal side-to-side anastomosis in robot-assisted right colectomy for colon cancer.

Simple technique of double-layer enterotomy closure using a bidirectional barbed suture material when performing intracorporeal side-to-side anastomosis in robot-assisted right colectomy for colon cancer.

Knotless barbed suture versus conventional polydioxanone suture material for intraoral surgical incisions - A randomized controlled trial

PurposeTo evaluate and compare the perioperative wound management and healing of intraoral surgical incisions between the conventional and knotless barbed Polydioxanone suture materials. Materials and methodsA Randomized Controlled Trial was conducted with well-constructed inclusion and exclusion criteria. 46 participants were allotted into the control and test groups based on a computer-generated randomization sequence. The materials used were 3–0 Stratafix™ knotless barbed PDS suture and conventional 3–0 Ethicon PDSTMII suture materials. Parameters assessed included intraoperative time taken for closure and assessment with Early Wound Healing Score (EHS) on postoperative day 1 and Landry, Turnbull, and Howley (LTH) Healing index on postoperative days 3 and 7. Statistical analyses were done using the Chi-square test and student's t-test with a p-value less than 0.05 indicating statistical significance. Results32 patients had surgical intervention for maxillofacial fracture management and 14 patient for orthognathic osteotomies. Surgical sites (n = 60) included maxillary and mandibular vestibules. Intraoperative closure time was better in the test group with statistical significance (p-value = 0.0472). The healing scores on the 3rd and 7th postoperative days were compared between the control and test groups exhibiting statistical significance favouring the test group. The p-values were 0.0479 and 0.0393 respectively. ConclusionTo conclude, our study concurred with the existing literature in terms of reduced operating time, and better wound healing observed with the knotless barbed suture. Along with statistical significance, all the variables exhibited clinical relevance and better wound management in the test group.

Comparison of incisional bursting strength of a bidirectional absorbable knotless suture material versus a standard continuous absorbable suture material for closure of the equine linea alba.

To evaluate the use of bidirectional knotless barbed suture material for closure of the equine linea alba. Laboratory study. Adult light horse cadavers (n = 24). A 25 cm incision was made through the linea alba, and a 200 L polyurethane bladder was positioned within the abdomen. The linea alba was closed either using USP2/EP5 bidirectional polydioxanone barbed suture or USP2/EP5 standard polydioxanone suture in a simple continuous pattern. Closure time was recorded for each suture type. The bladder was air-insufflated at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and wound failure modes were recorded. Suture length, closure time, bursting pressure, and failure modes were compared using Welch-Aspin t-tests. The incisional bursting pressure was comparable between the two groups (p > .05). Less suture material (p < .01) was required with the barbed suture than the standard suture. Closure time was less for the barbed suture than the standard suture (p < .01). Suture failure was the main failure mode in both groups (83% cases). Closure of the equine linea alba using bidirectional barbed suture material reduced the amount of foreign material in the wound and decreased closure time without compromising incisional strength. Bidirectional barbed suture material could be considered as an alternative to standard suture materials for closure of the equine line alba.

A novel knotless hand-sewn end-to-end anastomosis using V-loc barbed suture vs. stapled anastomosis in laparoscopic left colonic surgery: A propensity scoring match analysis.

Laparoscopic colectomy is widely practiced for colon cancer, but many variations exist for anastomosis after laparoscopic colon cancer radical resection. We retrospectively analyzed 226 patients who underwent laparoscopic-assisted radical resection for left colon cancer with knotless hand-sewn end-to-end anastomosis (KHEA) technique with barbed V-loc™ suture material and compared perioperative outcomes, safety, and efficacy to those undergoing stapled anastomosis from 2010 to 2021. After the 1:2 propensity score matching, 123 participants with similar preoperative characteristics (age, body mass index, TNM stage, and tumor location) were enrolled in the study: 41 in the KHEA and 82 in the stapler group. Statistically significant differences were found in time to accomplish the anastomosis (mean 7.9 vs. 11.9 min, p < 0.001) and hospital costs (mean 46,569.71 vs. 50,915.35 CNY, p < 0.05) that differed between the KHEA and stapler group, respectively. No statistically significant difference was found in the mean delay to bowel function recovery (2.6 vs. 2.7 days, p = 0.466), duration of hospital stay (8.6 vs. 7.9 days, p = 0.407), or rate of postoperative complications (14.6% vs. 11.0%, p = 0.563). Anastomotic leakage occurred in 11 patients: 5 (12.2%) vs. 6 (7.3%) (p > 0.05) in the KHEA and stapler group, respectively. KHEA is feasible and safe for anastomosis after laparoscopic left hemicolectomy. The KHEA technique could reduce operation time and hospital costs with complication rates comparable to stapling.

A survey on robotic-assisted laparoscopic myomectomy technique among high-volume gynecologic robotic surgeons in Korea

Objective: This study aimed to investigate the of robotic-assisted laparoscopic myomectomy (RALM) techniques among Korean gynecologic robotic surgeons with heavy robotic gynecologic caseloads.Methods: We conducted this online survey consisting of 11 questions regarding various aspects of RALM, such as the type of da Vinci system, number of skin incisions, trocar ports, robotic instruments, and suture materials, with a focus on multiport RALM. Twenty-one board-certified robotic gynecologic surgeons from 16 university-based tertiary medical centers responded.Results: The da Vinci Xi was the most commonly installed system at the respondents’ affiliated hospitals. In terms of instruments, monopolar curved scissors, fenestrated bipolar forceps, and mega suture needle driver were the most used. The most commonly used suture materials for serosal and myometrial layer closure were barbed suture materials, and the endometrial layer was most commonly closed with multifilament delayed absorbable suture material. Continuous running and baseball suture techniques were most frequently used for serosal layer closure.Conclusion: This is the first study investigating RALM surgical methods among Korean gynecologic robotic surgeon with heavy caseloads, and the findings can be of a great benefit to beginners as well as experts in the field of robotic surgery.

Risk factors of incisional hernia after single-incision cholecystectomy and safety of barbed suture material for wound closure.

PurposeSingle-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures.MethodsA total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon).ResultsThe two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The influence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia.ConclusionOur study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.

Comparison of Mesh and Barbed Suture for Laparoscopic Nephrosplenic Space Ablation in Horses.

Simple SummaryThe entrapment of the left large colon in the nephrosplenic space is a common cause of colic in horses but not in miniature horses and pony breeds. Different techniques have been proposed to prevent this problem, such as colopexy, large colon resection or nephrosplenic space (NSS) ablation. The most recent methods involve closing the NSS with a minimally invasive technique with the horse standing. Multiple techniques have been described for laparoscopic NSS ablation, among which are ablation with a barbed suture and ablation with prosthetic mesh. Although these two methods have been proposed as valid and effective, no direct comparison has yet been made between them. In this study, the two techniques are compared in terms of duration of surgery, short- and long-term complications, and costs.Nephrosplenic space (NSS) ablation has been demonstrated to be an effective technique for prevention of left dorsal displacement of the large colon and multiple laparoscopic techniques, among which ablation with mesh or with a barbed suture, have been proposed. Our objective was to compare two laparoscopic techniques for closure of the NSS in twenty-eight horses diagnosed with nephrosplenic entrapment. Medical records of horses that had laparoscopic NSS ablation in two referral centers between 2017–2019 were retrieved. Duration of surgery, complications, and short- and long-term follow-up information were collected and compared. Costs were also calculated and compared. All horses met the inclusion criteria: 9 had NSS ablation with a mesh implant (group M), 19 with barbed suture material (group B). One horse in group B had recurrent colic after discharge. At control laparoscopy after 5 months, the NSS resulted in still not being ablated because of a failure of the suture. In group M, three horses had recurrent colic. One was successfully treated medically, one died of unknown causes and the third required a second laparoscopic suturing at 3–6 months because of failure of the mesh implant. The mean time of surgery and costs were lower in group B compared to group M. The barbed suture technique was faster, more cost-effective and had a lower complication rate than the mesh implant.

Current Protocol for Aesthetic Scar Management in Thyroid Surgery.

We compared the scar quality when different protocols were applied, and eventually aim to find the optimal scar management protocol. We conducted a prospective, randomized, and blinded comparison of different scar management protocols in a single center. We allocated 126 patients who underwent thyroidectomy via collar neck incision randomly into three groups. Patients in group A were treated with tissue adhesive only. Patients in group B were treated by means of subcuticular suturing and early scar management with a non-ablative fractional laser (NAFL) and intralesional triamcinolone injection (ILI). Patients in group C had skin closure with tissue adhesive and early scar management. At 6 months after the operation, the Patient and Observer Scar Assessment Scale (POSAS) and the width of the final scar were compared. Comparing the sum of PSAS, groups B and C showed significant higher satisfaction than did group A (22.81 ± 11.66 in group A, 10.9 ± 5.14 in group B, and 15.19 ± 9.98 in group C). In the sum of OSAS, group B also showed a significant difference than did groups A and C (17.74 ± 6.75 in group A, 10.26 ± 3.60 in group B, and 14.52 ± 6.48 in group C). Also, group B showed a narrower scar width than did groups A and C. Our finding suggests that subcuticular suturing using barbed suture material and early treatment with a combination therapy using NAFL and ILI showed a favorable aesthetic outcome for both patients and operators. Based on our algorithmic approach for thyroidectomy scar, we anticipate an optimal aesthetic outcome. II Laryngoscope, 131:E2188-E2195, 2021.

Single-incision laparoscopic antrectomy for type I gastric neuroendocrine tumor: a case report

BackgroundType I gastric neuroendocrine tumors (GNETs) originate from hyperplasia of enterochromaffin­like (ECL) cells and are commonly detected in patients with chronic atrophic gastritis, including autoimmune gastritis. Typical treatment for type I GNETs comprises simple surveillance and/or endoscopic resection. For alleviation of hypergastrinemia resulting in ECL cell hypertrophy, antrectomy is a treatment option. Type I GNETs mostly have excellent prognosis, and if a surgical approach is chosen, the procedure must be minimally invasive. One such technique for multiple type I GNETs, minimally invasive single-incision laparoscopic antrectomy (SILA), is reported here for the first time.Case presentationWe performed SILA on a 46-year-old woman who developed type I GNETs caused by hypergastrinemia due to autoimmune gastritis. A Lap-Protector was inserted in a 3 cm incision at the umbilicus, and set an EZ Access equipped with two 5 mm trocars and one 12 mm trocar. Antrectomy without lymph node dissection was performed using a 5 mm forward-oblique viewing endoscope, a vessel sealing device, and linear staplers, while reconstruction was by Billroth I reconstruction. Side-to-side anastomosis was performed using a 45 mm linear stapler. The stapler entry hole was sutured intracorporeally using barbed suture material. The operation time was 140 min and blood loss was 5 ml. The patient was discharged ten days after surgery without complications. Serum gastrin level decreased to within the normal range on the day after the operation. One year after surgery, esophagogastroduodenoscopy showed pathological disappearance of all lesions of the remnant stomach.ConclusionsSILA is a minimally-invasive and tolerable technique for treatment of multiple type I GNETs. In this reported case there was good cohesiveness and effectiveness in normalizing gastrin levels and in elimination of remnant gastric lesions.

Safety of Barbed Suture Material for Wound Closure in Single Incisional Cholecystectomy

Single incisional cholecystectomy is surgical methods that provide comparable results to standard laparoscopic cholecystectomy (LC). However, single incisional cholecystectomy has been accused for post-operative incisional hernia. The incidence of incisional hernia after single incisional cholecystectomy is reported about 2.4% in short-term follow-up studies and up to 10.9% in long-term follow-up. One of incisional hernia's risk factor is surgical technique failure during wound closure. This study evaluated the incidence of patients developing incisional hernia after single incisional cholecystectomy, and we hope to suggest a solution in overcoming incisional hernia arising out surgical technique failure by using barbed suture material during wound closure. Total number of 984 patients underwent single incisional cholecystectomy between March 2014 and December 2019. During this period, there were 689 patients who underwent wound closure with non-barbed suture material and 295 patients with barbed suture material. Both Patient groups were comparable in age, gender, BMI and operation time. 2 patients developed incisional hernia in non-barbed suture group and none in the barbed suture group. The incidence of incisional hernia was higher in the non-barbed suture group, but statistically insignificant. (p=1.00) Our large volume study showed lower incidence of incisional hernia to comparing previous studies. Also, there was no incisional hernia patient in barbed suture group, although statistically insignificant, which means possibility of overcoming the surgical technique failure using barbed suture material. We hope to share our experience on safety and advantage of using barbed suture in wound closure leading to a decrease in the incidence of incisional hernia.

The Largest Uterine Leiomyoma Removed by Robotic-Assisted Laparoscopy in the Late Reproductive Age: A Case Report.

Uterine leiomyoma is a very common gynecological tumor in the reproductive years. Recent studies have shown that surgical treatment of uterine leiomyoma using robotic-assisted laparoscopic myomectomy (RALM) is associated with significantly fewer complications, lower estimated blood loss, fewer conversions, and less bleeding than conventional laparoscopic myomectomy. This study reports the case of a giant uterine leiomyoma treated using RALM. A 50-year-old woman was referred to our outpatient clinic with progressive abdominal distension. Ultrasonography and magnetic resonance imaging were performed and showed a markedly enlarged uterus containing a 28-cm uterine myoma. RALM confirmed the 28-cm subserosal myoma on the posterior wall of the uterus. The myoma was enucleated, and the myometrial and serosal defect was repaired with a continuous suture using barbed suture materials. The entire myoma was removed using an electric morcellator. The operation lasted for 190 minutes. The total weight of the removed myoma was 3,262 g, and uterine leiomyoma was pathologically diagnosed. There were no postoperative complications. Although the treatment of huge myomas using RALM is controversial and technically demanding, we successfully performed RALM in a patient with a large myoma. This case confirms the efficiency, reliability, and safety of a robotic-assisted laparoscopic approach for removing a huge myoma. In a well-selected case, RALM can be performed by experienced surgeons regardless of the size of fibroids.

Biomechanics Study of the Holding Power between Tendon and Suture Using Different Techniques.

Background: The holding power of a repaired flexor tendon injury is related to surface sutures, suture material and different techniques. Nowadays, a barbed suture material offers the possibility of knotless flexor tendon repair but many hospitals use non-barbed suture materials. The purpose of this study was to compare a barbed suture material and a non-barbed suture material for primary stability under static loading and increased knots in the non-barbed suture material (knot technique) for increased holding power of tendons in animal testing. Methods: Forty-five fresh porcine tendons were randomized into three groups: Group 1 (grasping technique group) used a four-strand core suture grasping a four-strand modified Kessler suture by non-barbed suture material [Non-absorbable monofilament polybutester 3-0] was used to repair the tendon with a surgical knot; in Group 2 (knot technique group) a four-strand core suture used the knot technique by non-barbed suture material [Non-absorbable monofilament polybutester 3-0] to repair the tendon with a continuous suture adding surgical knots in the same place as the surgical knot at the repair sites; and Group 3 (knotless technique group) used a four-strand core suture with the knotless technique in modified Kessler suture with barbed suture material [Non-absorbable monofilament polybutester 3-0] to repair the tendon without a knot. Our objective was to compare the ultimate tensile strength between the groups. Results: The mean tensile strength was 30.38 ± 5.04 N for group 1, 41.71 ± 2.62 for group 2 and 47.53 ± 4.89 for the group 3. The ANOVA test revealed a significant difference among the various techniques (p < 0.05). The highest tensile strength was found in the knotless technique using barbed suture material group. Conclusions: The knotless technique using barbed suture material demonstrated the highest tensile strength in suture repairs. The maximum tensile strength was significantly higher in this group.

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.

Effect of presurgical storage conditions on leakage pressures of enterotomy sites closed with unidirectional barbed suture material in fresh, chilled, and frozen-thawed cadaveric canine jejunal specimens.

To evaluate the effect of presurgical storage conditions on leakage pressures of enterotomy sites closed with unidirectional barbed suture material in fresh, chilled, and frozen-thawed cadaveric canine jejunal specimens. 36 grossly normal jejunal segments obtained from 4 dog cadavers. 9 jejunal segments were harvested immediately from each euthanized dog and randomly assigned to be tested within 4 hours after collection (fresh segments), stored at 4°C for 24 hours before testing (chilled segments), or stored at -20°C for 7 days and thawed at 21°C for 6 hours before testing (frozen-thawed segments). For leakage pressure testing, a 3-cm-long antimesenteric enterotomy was performed and repaired with 3-0 unidirectional barbed suture material in a simple continuous pattern in each segment. Time to complete the enterotomy, initial leakage pressure, maximum intraluminal pressure, and leakage location were recorded for each segment. Mean ± SD initial leakage pressure for fresh, chilled, and frozen-thawed segments was 52.8 ± 14.9 mm Hg, 51.8 ± 11.9 mm Hg, and 33.3 ± 7.7 mm Hg, respectively. Frozen-thawed segments had significantly lower mean initial leakage pressure, compared with findings for fresh or chilled segments. Time to complete the enterotomy, maximum intraluminal pressure, and leakage location did not differ among groups. Leak pressure testing of cadaveric jejunal segments that are fresh or chilled at 4°C for 24 hours is recommended for enterotomy studies involving barbed suture material in dogs. Freezing and thawing of cadaveric jejunal tissues prior to investigative use is not recommended because leak pressure data may be falsely low.

Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis.

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. 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. 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)). 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.

Comparison of initial leak pressures after single- and double-layer cystotomy closure with barbed and nonbarbed monofilament suture material in an ex vivo ovine model.

To compare initial leakage pressure after double-layer inverting and single-layer appositional closures with unidirectional barbed suture or an analogous monofilament absorbable suture in an ex vivo ovine model. Experimental study. Ovine cadaveric bladders (n = 48). A 4-cm ventral cystotomy was performed in each bladder. Bladders were randomly divided into 4 groups (n = 12 each group) and sutured in an open setting with a single-layer appositional or a double-layer inverting pattern of unidirectional 2-0 barbed or an analogous monofilament suture. Intraluminal pressure at initial leakage and leakage location were recorded. Analysis of variance was used to compare initial leak pressure between the 4 groups (P < .05). Ovine urinary bladders closed with double-layer inverting closures leaked at intraluminal pressures about twofold greater than bladders closed with single-layer appositional closures (P < .0001) whether barbed or nonbarbed suture was used (P ≥ .987). Bladders most commonly leaked at the suture hole after single-layer closure. Bladders that had been repaired with a double-layer closure leaked at the knot in nonbarbed closures or at the preconstructed end loop in barbed closures. Double-layer closure increased leakage pressures compared with single-layer closures, irrespective of the suture type used. This study provides evidence to support double-layer rather than single-layer closure of cystotomies in clinical cases. The use of barbed suture may be suitable for cystorrhaphy in sheep.

Comparison of two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs

BackgroundHand-sewn intestinal anastomoses are a fundamental procedure in both open and laparoscopic intestinal surgery. Self-retaining barbed suture devices have been tested for a variety of surgical applications. With the exception of clinical reports and various experimental studies on enterotomy, little has been published so far on the use of barbed suture for end-to-end intestinal anastomoses. The aim of the study was to compare two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. End-to-end jejuno-jejunal anastomosis were performed with unidirectional barbed (A group), bidirectional barbed (B group) or normal (C group) sutures in each animal. A comparison was then made between the groups based on adhesions scoring, suturing time, bursting pressure and histopathology.ResultsMean construction times in the A group (518 ± 40 s) and in the B group (487 ± 45 s) were significantly lower than in the C group (587 ± 63 s) but were not different between A and B group (P = 0.10). Mean bursting pressures were significantly higher in the intact intestine (197 ± 13 mmHg) than in any other group (group A 150 ± 16 mmHg, group B 145 ± 22 mmHg, group C 145 ± 24 mmHg). Among anastomotic techniques, the bursting pressures were not significantly different. Histologically no difference could be detected in the grade of inflammation, collagen deposition and neovascularization at the anastomotic sites.ConclusionsBarbed sutures can be effectively used for handsewn end-to-end jejunojejunal anastomosis in pigs. They are comparable to normal suture but could provide a shorter surgical time.

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.