The Effectiveness and Safety of Barbed Sutures in the Bariatric Surgery: a Systematic Review and Meta-analysis

Abstract

Background

Knotless barbed sutures can eliminate knot tying during the bariatric surgery (BS). Since effects reported on patients and surgeons are ambiguous, this study is determined to identify the effectiveness and safety of knotless barbed suture in BS.

Methods

PubMed, EMBASE, Cochrane Register of Clinical Studies, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) and cohort studies comparing barbed sutures with conventional sutures in BS (until July 2, 2018). Quality assessment was conducted due to Cochrane’s recommendations. Review Manager was applied to analyze the data, and we performed subgroup analyses based on study design type and surgery type.

Results

A total of four cohort studies (25,505 patients, low to moderate risk of bias) and four RCTs (1480 patients, low to moderate risk of bias) proved eligible. BS includes laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Comparing to conventional suture, pooling data showed that suture time (MD = − 4.87, 95%CI − 8.82 to − 0.92, P = 0.02) and operative time (MD = − 7.88, 95%CI − 14.10 to − 1.67, P = 0.01) declined significantly in the barbed group. Although no significant change was in the overall postoperative complications and hospital stay, subgroup analysis of RCTs suggested that significantly, fewer bleeding conditions happened in barbed groups.

Conclusions

Although quality of all the studies was relatively moderate and the number of the included studies was limited, the barbed suture may have the potentiality to be an effective and reliable technique and extend the application in other bariatric surgeries. More evidence with randomized design, larger sample sizes, and longer follow-up need to compel validations of this state-of-the-art in the future.

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

Fig. 1
Fig. 2

References

  1. 1.

    Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.

    Article  Google Scholar 

  2. 2.

    Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563–70.

    Article  Google Scholar 

  3. 3.

    Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961.

    Article  Google Scholar 

  4. 4.

    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.

    CAS  Article  Google Scholar 

  5. 5.

    Ritter EM, McClusky 3rd DA, Gallagher AG, et al. Real-time objective assessment of knot quality with a portable tensiometer is superior to execution time for assessment of laparoscopic knot-tying performance. Surg Innov. 2005;12(3):233–7.

    Article  Google Scholar 

  6. 6.

    Facy O, De Blasi V, Goergen M, et al. Laparoscopic gastrointestinal anastomoses using knotless barbed sutures are safe and reproducible: a single-center experience with 201 patients. Surg Endosc. 2013;27(10):3841–5.

    Article  Google Scholar 

  7. 7.

    Ruff GL. The history of barbed sutures. Aesthet Surg J. 2013;33(3 Suppl):12s–6s.

    PubMed  Google Scholar 

  8. 8.

    Warner JP, Gutowski KA. Abdominoplasty with progressive tension closure using a barbed suture technique. Aesthet Surg J. 2009;29(3):221–5.

    Article  Google Scholar 

  9. 9.

    Lin YF, Lai SK, Liu QY, et al. Efficacy and safety of barbed suture in minimally invasive radical prostatectomy: a systematic review and meta-analysis. Kaohsiung J Med Sci. 2017;33(3):107–15.

    Article  Google Scholar 

  10. 10.

    Lin Y, Lai S, Huang J, et al. The efficacy and safety of knotless barbed sutures in the surgical field: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2016;6:23425.

    CAS  Article  Google Scholar 

  11. 11.

    Weld KJ, Ames CD, Hruby G, et al. Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction. Urology. 2006;67(6):1133–7.

    Article  Google Scholar 

  12. 12.

    Rashid RM, Sartori M, White LE, et al. Breaking strength of barbed polypropylene sutures: rater-blinded, controlled comparison with nonbarbed sutures of various calibers. Arch Dermatol. 2007;143(7):869–72.

    Article  Google Scholar 

  13. 13.

    Rogula T, Khorgami Z, Bazan M, et al. Comparison of reinforcement techniques using suture on staple-line in sleeve gastrectomy. Obes Surg. 2015;25(11):2219–24.

    Article  Google Scholar 

  14. 14.

    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  15. 15.

    Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  Google Scholar 

  16. 16.

    Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  Google Scholar 

  17. 17.

    Costantino F, Dente M, Perrin P, et al. 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. 2013;27(10):3846–51.

    Article  Google Scholar 

  18. 18.

    Bautista T, Shabbir A, Rao J, et al. Enterotomy closure using knotless and barbed suture in laparoscopic upper gastrointestinal surgeries. Surg Endosc. 2016;30(4):1699–703.

    Article  Google Scholar 

  19. 19.

    De Blasi V, Facy O, Goergen M, et al. Barbed versus usual suture for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial. Obes Surg. 2013;23(1):60–3.

    Article  Google Scholar 

  20. 20.

    Vidarsson B, Sundbom M, Edholm D. Shorter overall operative time when barbed suture is used in primary laparoscopic gastric bypass: a cohort study of 25,006 cases. Surg Obes Relat Dis. 2017;13(9):1484–8.

    Article  Google Scholar 

  21. 21.

    Milone M, Di Minno MN, Galloro G, et al. 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. 2013;23(9):756–9.

    Article  Google Scholar 

  22. 22.

    Gys B, Gys T, Lafullarde T. The use of unidirectional knotless barbed suture for enterotomy closure in Roux-en-Y gastric bypass: a randomized comparative study. Obes Surg. 2017;27(8):2159–63.

    Article  Google Scholar 

  23. 23.

    Hany M, Ibrahim M. Comparison between stable line reinforcement by barbed suture and non-reinforcement in sleeve gastrectomy: a randomized prospective controlled study. Obes Surg. 2018;28:2157–64.

    Article  Google Scholar 

  24. 24.

    Carandina S, Tabbara M, Bossi M, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: absorbable monofilament, barbed suture, fibrin glue, or nothing? Results of a prospective randomized study. J Gastrointestin Surg. 2016;20(2):361–6.

    CAS  Article  Google Scholar 

  25. 25.

    Kadirkamanathan SS, Shelton JC, Hepworth CC, et al. A comparison of the strength of knots tied by hand and at laparoscopy. J Am Coll Surg. 1996;182(1):46–54.

    CAS  PubMed  Google Scholar 

  26. 26.

    Maconi G, Sampietro GM, Parente F, et al. Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study. Am J Gastroenterol. 2003;98(7):1545–55.

    Article  Google Scholar 

  27. 27.

    Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology. 2002;224(1):9–23.

    Article  Google Scholar 

  28. 28.

    Yavuz A, Bulus H. The effect of reinforcement methods with knotted and knotless sutures: comparison of burst pressures. J Laparoendosc Adv Surg Tech A. 2017;27(6):629–32.

    Article  Google Scholar 

  29. 29.

    Vakil JJ, O’Reilly MP, Sutter EG, et al. Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplast. 2011;26(5):710–3.

    Article  Google Scholar 

  30. 30.

    Gililland JM, Anderson LA, Sun G, et al. Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA. Clin Orthop Relat Res. 2012;470(1):125–9.

    Article  Google Scholar 

  31. 31.

    Zorn KC, Trinh QD, Jeldres C, et al. Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit. BJU Int. 2012;109(10):1526–32.

    Article  Google Scholar 

Download references

Funding

This study is supported by Grant No. 81403276 and No. 81873197 from the National Natural Science Foundation of China and Grant No. JH20140066 from the Technology Support Program of Science and Technology Department of Sichuan Province.

Author information

Affiliations

Authors

Contributions

Y Lin: project development, data analysis and management, manuscript writing, and editing

Y Long, S Lai, and Q Guo: data collection

L Du and Y Zhang: data analysis and management, manuscript writing, and editing

J Huang: data analysis and project development

Corresponding authors

Correspondence to Jin Huang or Liang Du.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 28 kb)

Appendix Figure 1

A forest plot of subgroup analysis of suture time based on study design types (PNG 17 kb)

Appendix Figure 2

A forest plot of subgroup analysis of operative time based on study design types (PNG 18 kb)

Appendix Figure 3

A forest plot of subgroup analysis of hospital stay based on study design types (PNG 17 kb)

Appendix Figure 4

A forest plot of subgroup analysis of postoperative complications based on study design types (PNG 18 kb)

Appendix Figure 5

A forest plot of subgroup analysis of bleeding based on study design types (PNG 16 kb)

Appendix Figure 6

A forest plot of subgroup analysis of stenosis based on study design types (PNG 16 kb)

Appendix Figure 7

A forest plot of subgroup analysis of leak based on study design types (PNG 17 kb)

Appendix Figure 8

A forest plot of subgroup analysis of suture time based on bariatric surgery types (PNG 16 kb)

Appendix Figure 9

A forest plot of subgroup analysis of operative time based on bariatric surgery types (PNG 17 kb)

Appendix Figure 10

A forest plot of subgroup analysis of hospital stay based on bariatric surgery types (PNG 17 kb)

Appendix Figure 11

A forest plot of subgroup analysis of postoperative complications based on bariatric surgery types (PNG 17 kb)

Appendix Figure 12

A forest plot of subgroup analysis of bleeding based on bariatric surgery types (PNG 16 kb)

Appendix Figure 13

A forest plot of subgroup analysis of stenosis based on bariatric surgery types (PNG 16 kb)

Appendix Figure 14

A forest plot of subgroup analysis of leak based on bariatric surgery types (PNG 17 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lin, Y., Long, Y., Lai, S. et al. The Effectiveness and Safety of Barbed Sutures in the Bariatric Surgery: a Systematic Review and Meta-analysis. OBES SURG 29, 1756–1764 (2019). https://doi.org/10.1007/s11695-019-03744-4

Download citation

Keywords

  • Barbed suture
  • Bariatric surgery
  • Surgical technique
  • Systematic review