Advertisement

Surgical Endoscopy

, Volume 30, Issue 8, pp 3630–3635 | Cite as

Knotless choledochorraphy with barbed suture, safe and feasible

  • Luis C. Fernandez
  • Augusto Toriz
  • Jorge Hernandez
  • Norberto Sanchez
  • Erick Linares
  • Massiel Zenteno
  • Adolfo Cuendis
  • Jose Olivares
  • Gustavo Guerrero
  • Cesar F. Cervantes
Dynamic Manuscript

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.

Keywords

V-Loc Barbed suture Bile ducts Choledochoraphy Choledochal closure Knotless suture 

Notes

Compliance with ethical standards

Disclosures

Luis C. Fernandez, Augusto Toriz, Jorge Hernandez, Norberto Sanchez, Erick Linares, Massiel Zenteno, Adolfo Cuendis, Gustavo Guerrero, Jose Olivares and Cesar F. Cervantes have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2015_4620_MOESM1_ESM.mov (32.1 mb)
Supplementary material 1 (MOV 32886 kb)

References

  1. 1.
    Sukharamwala P, Haq S, Amini B, Parikh N, Smith J, Ghani A, & DeVito P (2013) Primary choledochorrhaphy versus T-tube drainage for choledocholithiasis: a meta-analysis and systematic review. Surg J Resid Fellows 1(1):13–19Google Scholar
  2. 2.
    Payne RA, Woods WGA (1986) Primary suture or T-tube drainage after choledochotomy. Ann R Coll Surg Engl 68:196–198PubMedPubMedCentralGoogle Scholar
  3. 3.
    Sheen-Cheng S-M, Chou F-F (1990) Choledochotomy for biliary lithiasis: is routine T-Tube drainage necessary? A prospective controlled trial. Acta Chir Scand 156:387–390Google Scholar
  4. 4.
    Petelin JB, Lechleitner RA (1997) Laparoscopic choledochotomy without T-tube drainage is effective and safe. Abstract and Poster. SAGES Annual Scientific SessionGoogle Scholar
  5. 5.
    Martin IJ, Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures. Ann Surg 228(1):29–34CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Croce E, Golia M, Azzola M et al (1996) Laparoscopic choledochotomy with primary closure: follow-up (5–44 months) of 31 patients. Surg Endosc 10(11):1064–1068CrossRefPubMedGoogle Scholar
  7. 7.
    Drouard F, Passone-Szerzyna N, Berthou JC (1997) Laparoscopic treatment of common bile duct stones. Hepatogastroenterology 44:16–21PubMedGoogle Scholar
  8. 8.
    Millat B, Atger J, Deleuze A, Briandet H, Fingerhut A, Guillon F, Marrel E, DeSeguin C, Soulier P (1997) Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients. Hepatogastroenterology 44:28–34PubMedGoogle Scholar
  9. 9.
    Hanna GB, Frank TG, Cuschieri A (1997) Objective assessment of endoscopic knot quality. Am J Surg 174:410–413CrossRefPubMedGoogle Scholar
  10. 10.
    Joice P, Hanna GB, Cuschieri A (1998) Ergonomic evaluation of laparoscopic bowel suturing. Am J Surg 176:373–378CrossRefPubMedGoogle Scholar
  11. 11.
    Mansberger AR, Jennings ER, Smith EP Jr, Yeager GH (1951) A new type pull-out wire for tendon surgery: a preliminary report. Bull Sch Med Univ MD 36(3):119–121PubMedGoogle Scholar
  12. 12.
    Demyttenaere SV, Nau P, Henn M, Beck C, Zaruby J, Primavera M, Kirsch D, Miller J, Liu JJ, Bellizzi A, Melvin WS (2009) Barbed suture for gastrointestinal closure: a randomized control trial. Surg Innov 16:237–242CrossRefPubMedGoogle Scholar
  13. 13.
    Milone M, Nicola M, Di-Minno M, Galloro G, Maietta P, Bianco P, Milone F, Musella M (2013) 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 23(9):756–759CrossRefPubMedGoogle Scholar
  14. 14.
    Omotosho P, Yurcisin B, Ceppa E, Miller J, Kirsch D, Portenier DD (2011) In vivo assessment of an absorbable and non-absorbable knotless barbed suture for laparoscopic single-layer enterotomy closure: a clinical and biomechanical comparison against nonbarbed suture. J Laparoendosc Adv Surg Tech A 21:893–897CrossRefPubMedGoogle Scholar
  15. 15.
    Facy O, De Blasi V, Goergen M, Arru L, De Magistris L et al (2013) Laparoscopic gastrointestinal anastomoses using knotless barbed sutures are safe and reproducible: a single-center experience with 201 patients. Surg Endosc 27:3841–3845CrossRefPubMedGoogle Scholar
  16. 16.
    De Blasi V, Facy O, Goergen M et al (2013) Barbed versus usual suture for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial. Obes Surg 23:60–63CrossRefPubMedGoogle Scholar
  17. 17.
    Takayama S (2012) Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair. World J Gastrointest Surg 4(7):177–179CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lyons C, Joseph R, Salas N, Reardon P, Bass B, Dunkin B (2012) Mesh fixation with a barbed anchor suture results in significantly less strangulation of the abdominal wall. Surg Endosc 26:1254–1257CrossRefPubMedGoogle Scholar
  19. 19.
    Nawfal K, Eisenstein D, Theoharis E, Dahlman M, Wegienka G (2012) Vaginal cuff closure during robotic-assisted total laparoscopic hysterectomy: comparing vicryl to barbed sutures. JSLS 16:525–529CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Greenberg JA, Einarsson JI (2008) The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy. J Minim Invasive Gynecol 15(5):621–623CrossRefPubMedGoogle Scholar
  21. 21.
    Angioli R, Plotti F, Montera R, Damiani P, Terranova C, Oronzi I, Luvero D, Scaletta G, Muzii L, Panici P (2012) A new type of absorbable barbed suture for use in laparoscopic myomectomy. Int J Gynaecol Obstet 117(3):220–223CrossRefPubMedGoogle Scholar
  22. 22.
    Matsuhashi N, Takahashi T, Nonaka K, Tanahashi T, Imai H, Sasaki Y, Tanaka Y, Okumura N, Yamaguchi K, Osada S, Yoshida K (2013) Laparoscopic technique and safety experience with barbed suture closure for pelvic cavity after abdominoperineal resection. World J Surg Oncol 27(11):115CrossRefGoogle Scholar
  23. 23.
    Jeon SH, Jung S, Son HS, Kimm SY, Chung BI (2013) The unidirectional barbed suture for renorrhaphy during laparoscopic partial nephrectomy: Stanford experience. J Laparoendosc Adv Surg Tech A 23(6):521–525CrossRefPubMedGoogle Scholar
  24. 24.
    Chapman S, Turo R, Cross W (2011) Vesicourethral anastomosis using V-Loc TM barbed suture during robot-assisted radical prostatectomy. Cent Eur J Urol 64(4):236CrossRefGoogle Scholar
  25. 25.
    Zorn KC, Widmer H, Lattouf JB, Liberman D, Bhojani N, Trinh QD, Sun M, Karakiewicz PI, Denis R, El-Hakim A (2011) Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-LOC 180 suture. Can Urol Assoc J 5(3):188–194CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Pham KN, Sack BS, O’Connor RC, Guralnick ML, Langenstroer P, See WA, Jacobsohn K (2013) V-Loc urethro-intestinal anastomosis during robotic cystectomy with orthotopic urinary diversion. Can Urol Assoc J 7(11–12):E663–E666PubMedPubMedCentralGoogle Scholar
  27. 27.
    Tewari AK, Srivastava A, Sooriakumaran P, Slevin A, Grover S, Waldman O, Rajan S, Herman M, Berryhill R Jr, Leung R (2010) Use of a novel absorbable barbed plastic surgical suture enables a ‘‘Self-Cinching’’ technique of vesicourethral anastomosis during robot-assisted prostatectomy and improves anastomotic times. J Endourol 24(10):1645–1650CrossRefPubMedGoogle Scholar
  28. 28.
    Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149(5):680–688CrossRefPubMedGoogle Scholar
  29. 29.
    Mirrizzi PL (1942) Primary suture of the common bile duct in choledocholithiasis. Arch Surg 44:44–54CrossRefGoogle Scholar
  30. 30.
    Brewster OM (1957) Primary suture of the common bile duct; comparison with cases treated by standard methods. Can Med Assoc J 77(12):1111–1113PubMedPubMedCentralGoogle Scholar
  31. 31.
    Jeans P, Hall P, Liu Y, Baker R, Holt A, Saccone G, Harvey J, Scicchitano J, Toouli J (1993) MAXON is an optimal suture for bile duct anastomoses en pigs. HPB Surg 7(2):111–124CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Rashid RM, Sartori M, White LE, Villa MT, Yoo SS, Alam M (2007) Breaking strength of barbed polypropylene sutures: rater-blinded, controlled comparison with non-barbed sutures of various calibers. Arch Dermatol 143:869–872CrossRefPubMedGoogle Scholar
  33. 33.
    Nemecek E, Negrin L, Beran C, Nemecek R, Hollinsky C (2013) The application of the V-Loc closure device for gastrointestinal sutures: a preliminary study. Surg Endosc 27:3830–3834CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Luis C. Fernandez
    • 1
    • 5
  • Augusto Toriz
    • 1
    • 4
  • Jorge Hernandez
    • 1
  • Norberto Sanchez
    • 1
  • Erick Linares
    • 1
  • Massiel Zenteno
    • 1
  • Adolfo Cuendis
    • 2
  • Jose Olivares
    • 3
  • Gustavo Guerrero
    • 4
  • Cesar F. Cervantes
    • 4
    • 5
  1. 1.Hospital General Zona NortePueblaMexico
  2. 2.Hospital General “Dr. Manuel Gea Gonzalez”Mexico CityMexico
  3. 3.Hospital General ISSSTEMexicaliMexico
  4. 4.Hospital General ISSSTEPueblaMexico
  5. 5.Centro Integral de Enfermedades DigestivasSan Pedro CholulaMexico

Personalised recommendations