Updates in Surgery

, Volume 71, Issue 1, pp 113–120 | Cite as

Barbed vs conventional sutures in bariatric surgery: a propensity score analysis from a high-volume center

  • Francesco Pennestrì
  • Pierpaolo Gallucci
  • Francesca Prioli
  • Piero Giustacchini
  • Luigi Ciccoritti
  • Luca SessaEmail author
  • Rocco Bellantone
  • Marco Raffaelli
Original Article


The use of barbed sutures for constructing an anastomosis is favoured by a few bariatric surgeons as compared to conventional sutures. The aim of this study is to assess safety and efficacy of barbed sutures to close the gastric pouch–jejunal anastomosis (GPJA) in laparoscopic gastric bypass (Roux-en-Y gastric bypass—RYGB, and One-Anastomosis gastric bypass—OAGB) using propensity score-matching (PSM) analysis. A retrospective analysis of patients who underwent primary laparoscopic gastric bypasses between January 2012 and December 2017 was performed. Patients were divided into two different groups (RYGB-G and OAGB-G). PSM analysis was performed to minimize patient selection bias between the two types of sutures (barbed—BS and conventional—CS) in each group. A total of 808 patients were reviewed. After PSM, 488 (244 BS vs 244 CS) patients in RYGB-G and 48 in OAGB-G (24 BS vs 24 CS) patients were compared. Median operative time was significantly shorter (p < 0.001) for BS in RYGB-G. In OAGB-G, BS were associated with a shorter operative time, although no significant difference was observed (p = 0.183). Post-operative hospital stay was significantly shorter for BS in both the groups (p < 0.001). Post-operative 30th-day complications were comparable: no leakage or bleeding of GPJA was observed in BS groups. At median follow-up of 28.78 months, no late complications were observed. Barbed sutures appear to be effective to close GPJA during gastric bypass and as safe as conventional suture. Further studies are necessary to draw definitive conclusions.


Roux-en-Y gastric bypass One-anastomosis gastric bypass Barbed sutures Stratafix™ Bariatric surgery 


Author contributions

Study conception and design: FP and LS. Acquisition of data: PG and FP. Analysis and interpretation of data: PG and LC. Drafting of manuscript: FP and LS. Critical revision of manuscript: RB and MR

Compliance with ethical standards

Conflict of interest

All authors mentioned in this study do not have any competing interest. This specific report does not endorse any specific Company.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants for whom identifying information is included in this article.


  1. 1.
    Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP (2001) The continuing epidemics of obesity and diabetes in the United States. JAMA 286(10):1195–1200CrossRefGoogle Scholar
  2. 2.
    Raffaelli M, Guidone C, Callari C, Iaconelli A, Bellantone R, Mingrone G (2014) Effect of gastric bypass versus diet on cardiovascular risk factors. Ann Surg 259(4):694–699CrossRefGoogle Scholar
  3. 3.
    Sjöström L (2000) Surgical intervention as a strategy for treatment of obesity. Endocrine 13:213–230CrossRefGoogle Scholar
  4. 4.
    Costantino F, Dente M, Perrin P, Sarhan FA, Keller P (2013) Barbed unidirectional V-Loc 180 sutures in laparoscopic Roux-en-Y gastric bypass: a study comparing unidirectional barbed monofilament and multifilament suture. Surg Endosc 27(10):3846–3851CrossRefGoogle Scholar
  5. 5.
    World Health Organization (2011) Fact sheet number 311. Retrieved May 2011 from Accessed 9 Dec 2017
  6. 6.
    Fegal KM, Carroll MD, Ogen CL, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288:1723–1727CrossRefGoogle Scholar
  7. 7.
    Fisher BL, Schauer P (2002) Medical and surgical options in the treatment of severe obesity. Am J Surg 184:9S–16SCrossRefGoogle Scholar
  8. 8.
    Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D (2003) Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg 238:467–484Google Scholar
  9. 9.
    Suter M, Donadini A, Romy S, Demartines N, Giusti V (2011) Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg 254:267–273CrossRefGoogle Scholar
  10. 10.
    Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, Yu B, Min Z (2015) Efficacy of laparoscopic mini gastric bypass for obesity and type 2 diabetes mellitus: a systematic review and meta-analysis. Gastroenterol Res Pract. Google Scholar
  11. 11.
    Bruzzi M, Rau C, Voron T, Guenzi M, Berger A, Chevallier JM (2015) Single anastomosis or mini-gastric bypass: long-term results and quality of life after 5-year follow-up. Surg Obes Relat Dis 11(2):321–326CrossRefGoogle Scholar
  12. 12.
    Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138:181–184CrossRefGoogle Scholar
  13. 13.
    Jones KB Jr (2010) Commentary re: laparoscopic versus open gastric bypass. Obes Surg 20:380–382CrossRefGoogle Scholar
  14. 14.
    De Blasi V, Facy O, Georgen M, Poulain V, De Magistris L, Azagra JS (2013) Barbed versus usual sutures for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial. Obes Surg 23:60–63CrossRefGoogle Scholar
  15. 15.
    Demyttenaere SV, Nau P, Henn M, Beck C, Zaraby J, Primavera M, Kirsch D, Miller J, Liu JJ, Bellizzi A, Melvis WS (2009) Barbed suture for gastrointestinal closure: a randomized control trial. Surg Innov 16:237–242CrossRefGoogle Scholar
  16. 16.
    Lee SW, Nomura E, Tokuhara T, Kawai M, Matsuhashi N, Yokoyama K, Fujioka H, Hiramatsu M, Okuda J, Uchiyama K (2011) Laparoscopic technique and initial experience with knotless, unidirectional barbed suture closure for staple-conserving, delta-shaped gastroduodenostomy after distal gastrectomy. J Am Coll Surg 213:39–45CrossRefGoogle Scholar
  17. 17.
    Omotosho P, Yurcisin B, Ceppa E, Miller J, Kirsch D, Portenier DD (2011) In vivo assessment for an absorbable and nonabsorbable knotless barbed suture for laparoscopic single-layer enterotomy closure: a clinical and biomechanical comparison against nonbarbed suture. J Laparoendosc Adv Surg Tech A 21:893–897CrossRefGoogle Scholar
  18. 18.
    Tyner RP, Clifton GT, Fenton SJ (2013) Hand-sewn gastrojejunostomy using knotless unidirectional barbed absorbable suture during laparoscopic gastric bypass. Surg Endosc 27:1360–1366CrossRefGoogle Scholar
  19. 19.
    Hemal AK, Agarwal MM, Babbar P (2012) Impact of newer unidirectional and bidirectional barbed suture on vescicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol 44:125–132CrossRefGoogle Scholar
  20. 20.
    Morgan ME, Marsh C, Perrotti M (2007) Bidirectional-barbed sutured knotless running anastomosis V classic van Velthoven suturing in a model system. J Endourol 21:1175–1178CrossRefGoogle Scholar
  21. 21.
    Murtha AP, Kaplan AL, Paglia MJ, Millis BB, Feldstein ML, Ruff GL (2006) Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg 117:1769–1780CrossRefGoogle Scholar
  22. 22.
    Polland AR, Graversen JA, Mues AC, Badani KK (2011) Plyglyconate unidirectional barbed suture for posterior reconstruction and anastomosis during robot-assisted prostatectomy: effect on procedure time, efficacy, and minimum 6-month follow-up. J Endourol 25:1493–1496CrossRefGoogle Scholar
  23. 23.
    Siedhoff MT, Yunker AC, Steege JF (2011) Decreased incidence of vaginal cuff dehiscence after laparoscopic closure with bidirectional barbed suture. J Minim Invasive Gynecol 18:218–223CrossRefGoogle Scholar
  24. 24.
    Zorn KC, Trinh Q-D, Jeldres C, Schmitges J, Widmer H, Lattouf J-B, Sammon J, Liberman D, Sun M, Bianchi M, Karakiewicz PI, Denis R, Gautam G, El-Hakim A (2012) Prospective randomized trial of barbed polyglyconate suture to facilitate vescico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit. BJU 109(10):1526–1532CrossRefGoogle Scholar
  25. 25.
    Lee SW, Nomura E, Tokuhara T, Kawai M, Matsuhashi N, Yokoyama K, Fujioka H, Hiramatsu M, Okuda J, Uchiyama K (2011) Laparoscopic technique and initial experience with knotless, unidirectional barbed suture closure for staple-conserving, delta-shaped gastroduodenostomy after distal gastrectomy. J Am Coll Surg 213:39–45CrossRefGoogle Scholar
  26. 26.
    Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG (2011) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88(9):1157–1168CrossRefGoogle Scholar
  27. 27.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefGoogle Scholar
  28. 28.
    Foschi D, De Luca M, Sarro G, Bernante P, Zappa MA, Moroni R, Navarra G, Foletto M, Ceriani V, Piazza L, Di Lorenzo N (2016) Linee Guida di Chirurgia dell’obesità. Edizione 2016. Available from: Accessed 9 Dec 2017
  29. 29.
    Agnes A, Callari C, Raffaelli M (2017) The unexpected evolution of an expected complication: hemophagocytic lymphohistiocytosis. Obes Surg 27(1):205–207CrossRefGoogle Scholar
  30. 30.
    Milone M, Di Minno MND, Galloro G, Maietta P, Bianco P, Milone F, Musella M (2013) Safety and efficacy of barbed sutures for gastrointestinal suture: a prospective and randomized study on obese patients undergoing gastric bypass. J Laparoendosc Adv Surg Tech A 23(9):756–759CrossRefGoogle Scholar
  31. 31.
    (1992) Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr 55:615–619Google Scholar
  32. 32.
    Puzziferri N, Nakonezny PA, Livingston EH, Carmody TJ, Provost DA, Rush AJ (2008) Variations of weight loss following gastric bypass and gastric band. Ann Surg 248:233–242CrossRefGoogle Scholar
  33. 33.
    DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235:640–645CrossRefGoogle Scholar
  34. 34.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529CrossRefGoogle Scholar
  35. 35.
    Covidien (2011) V-loc wound closure device. Accessed 19 Oct 2013
  36. 36.
    Bautista T, Shabbir A, Rao J, So J, Kono K, Durai P (2015) Enterotomy closure using knotless and barbed suture in laparoscopic upper gastrointestinal surgeries. Surg Endosc 30(4):1699–1703CrossRefGoogle Scholar
  37. 37.
    Matsuhashi N, Takahashi T, Nonaka K, Tanahashi T, Imai H, Sasaki Y, Tanaka Y, Okumura N, Yamaguchi K, Osada S, Yoshida K (2016) Laparoscopic technique and safety experience with barbed suture closure for pelvic cavity after abdominoperineal resection. World J Surg Oncol 11:115. CrossRefGoogle Scholar
  38. 38.
    Ferrer-Márquez M, Belda-Lozano R, Soriano-Maldonado A (2016) Use of barbed sutures in bariatric surgery. Rev Lit I 26(8):1964–1969Google Scholar
  39. 39.
    Palmisano S, Giuricin M, Makovac P, Casagranda B, Piccinni G, de Manzini N (2014) Totally hand-sewn anastomosis using barbed suture device during laparoscopic gastric bypass in obese. A feasibility study and preliminary results. Int J Surg 12(12):1385–1389CrossRefGoogle Scholar
  40. 40.
    Ruiz de Adana JC, Hernández Matías A, Hernández Bartolomé M, Manzanedo Romero I, Leon Ledesma R, Valle Rubio A, López Herrero J, Limones Esteban M (2009) Risk of gastrojejunal anastomotic stricture with multifilament and monofilament sutures after hand-sewn laparoscopic gastric bypass: a prospective cohort study. Obes Surg 19:1274–1277CrossRefGoogle Scholar
  41. 41.
    Contival N, Menahem B, Gautier T, Le Roux Y, Alves A (2017) Guiding the non-bariatric surgeon through complications of bariatric surgery. J Visc Surg 155(1):27–40CrossRefGoogle Scholar
  42. 42.
    Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT (2003) Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 138:957–961CrossRefGoogle Scholar
  43. 43.
    Blanc P, Lointier P, Breton C, Debs T, Kassir R (2015) 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 25(12):2457–2460CrossRefGoogle Scholar
  44. 44.
    Buchs NC, Ostermann S, Hauser J, Roche B, Iselin CE, Morel P (2012) Intestinal obstruction following use of laparoscopic barbed suture: a new complication with new material? Minim Invasive Ther Allied Technol 21(5):369–371CrossRefGoogle Scholar
  45. 45.
    Donnellan NM, Mansuria SM (2011) Small bowel obstruction resulting from laparoscopic vaginal cuff closure with a barbed suture. J Minim Invasive Gynecol 18(4):528–530CrossRefGoogle Scholar
  46. 46.
    Segura-Sampedro JJ, Ashrafian H, Navarro-Sánchez A, Jenkins JT, Morales-Conde S, Martínez-Isla A (2015) Small bowel obstruction due to laparoscopic barbed sutures: an unknown complication? Rev Esp Enferm Dig 107(11):677–680Google Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  1. 1.U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  2. 2.Università Cattolica del Sacro CuoreRomeItaly

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