Skip to main content
Log in

Enterotomy closure using knotless and barbed suture in laparoscopic upper gastrointestinal surgeries

  • Technique
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Barbed sutures are recently being employed in intracorporeal suturing in various laparoscopic digestive surgeries. The purpose of this paper was to present our initial experience of enterotomy closure with barbed sutures in upper gastrointestinal and bariatric surgeries, and share optimal technique of using such sutures for enterotomy closure.

Methods

Fifty patients who underwent laparoscopic closure of enterotomies using barbed sutures were identified in two institutions in Singapore from January 2012 to December 2013. Patient demographics, short-term operative outcomes including anastomotic time, onset of diet, hospital stay, and early post-operative complications are reported.

Results

In 50 patients a total of 62 anastomotic sites were closed with barbed sutures. The barbed sutures appear to reduce mean anastomotic suturing time of the Roux-en-Y gastrojejunal closure (17.34 vs 44.55 min, p value 0.0001) and jejunojejunal closure (19.46 vs 31.01 min, p value 0.0013) when compared to a subgroup of patients with the same anastomotic sites closed using the standard non-barbed suture. The mean onset to start on diet was 2 ± 1.5 days and mean duration of hospital stay is 7 + 5.3 days. One (1.6 %) anastomotic leak was observed day 3 after a gastric bypass in the series. This leak was the result of a technical error due to inappropriate suturing technique. There were no mortalities, other complications or readmission. While applying traction on the suture brings two tissue edges closer, we observed that pushing the tissues toward each other provided more apposition and prevented unnecessary tearing of tissues that could potentially result in complications

Conclusions

Barbed closure sutures appear to be safe and effective in laparoscopic upper gastrointestinal procedures for closing enterotomies provided appropriate technique is used. The potential benefit is simplifying intracorporeal enterotomy closure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Vinuela EF, Gonon M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer. Ann Surg 225:446–456

    Article  Google Scholar 

  2. Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T, Baba H (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2374–2379

    Article  PubMed  Google Scholar 

  3. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Smith BR, Schauer P, Nguyen NT (2011) Surgical approaches to the treatment of obesity: bariatric surgery. Med Clin N Am 95:1009–1030

    Article  PubMed  Google Scholar 

  5. Allen JW, Rivas H, Cacchione RN, Ferzli GS (2003) Intracorporeal suturing and knot tying broadens the clinical applicability of laparoscopy. JSLS 7:137–140

    PubMed  PubMed Central  Google Scholar 

  6. Croce E, Olmi S (2000) Intracorporeal knot-tying in laparoscopic surgery: technical details. JSLS 4:17–22

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Kim H, Hyung WJ, Cho GS, Kim MC, Han S, Kim W, Ryu S, Lee H (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer. Ann Surg 251:417–420

    Article  PubMed  Google Scholar 

  8. Huang CK, Lee YC, Hung CM, Chen YS, Tai CM (2008) Laparoscopic Roux-en-Y gastric bypass for morbidly obese chinese patients: learning curve, advocacy, and complications. Obes Surg 18:776–781

    Article  PubMed  Google Scholar 

  9. Covidien. V-loc wound closure device. http://www.covidien.com/vloc/pages.aspx. Accessed 19 Oct 2013

  10. Greenberg JA (2010) The use of barbed sutures in obstetrics and gynecology. Rev Obstet Gynecol 10:82–91

    Google Scholar 

  11. Alessandri F, Remorgida V, Venturini PL (2010) Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study. J Minim Invasive Gynecol 6:1–5

    Google Scholar 

  12. Gussous YM, Zhao C, Amadio PC, An K (2011) The resurgence of barbed suture and connecting devices for use in flexor tendon tenorrhaphy. Hand 6:268–275

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mansour A, Ballard R, Garg S, Baulesh D, Erickson M (2013) The use of barbed sutures during scoliosis fusion wound closure: a quality improvement analysis. J Pediatr Orthop 33:786–790

    Article  PubMed  Google Scholar 

  14. De Blacam C, Colakoglu S, Momoh A, Lin S, Tobias A, Lee B (2012) Early experience with barbed sutures for abdominal closure in deep inferior epigastric perforator flap breast reconstruction. ePlasty 5:231–236

    Google Scholar 

  15. Zaruby J, Gingras K, Taylor J, Maul D (2011) An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure: biomechanical wound strength and histology. ASJ 31(2):232–240

    Google Scholar 

  16. Shah HN, Nayyar R, Rajamahanty S, Hemal A (2012) Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: wake forrest university experience. Int Urol Nephrol 44:775–785

    Article  PubMed  Google Scholar 

  17. Hemal A, Agarwal MM, Babbar P (2012) Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol 44:125–132

    Article  PubMed  Google Scholar 

  18. 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 abdominal perineal resection. World J Surg Oncol 11:1–15

    Article  Google Scholar 

  19. Takayama S, Nakai N, Shiozaki M, Ogawa R, Sakamoto M, Takeyama H (2012) Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair. World J Gastrointest Surg 4(7):177–179

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee S, 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:e39–e45

    Article  PubMed  Google Scholar 

  21. Constantino F, Dente M, Perrin P, Sarhan FA, Keller P (2013) Barbed unidirectional v-loc 180 suture in laparoscopic Roux-en-Y gastric bypass: a study comparing unidirectional barbed monofilament and multifilament absorbable suture. Surg Endosc 27:3846–3851

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Asim Shabbir.

Ethics declarations

Disclosures

Therese Bautista, Asim Shabbir, Jaideepraj Rao, Jimmy So, Koji Kono and Pradeep Durai declare that they have no conflict of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bautista, T., Shabbir, A., Rao, J. et al. Enterotomy closure using knotless and barbed suture in laparoscopic upper gastrointestinal surgeries. Surg Endosc 30, 1699–1703 (2016). https://doi.org/10.1007/s00464-015-4395-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4395-3

Keywords

Navigation