Barbed versus conventional thread used in laparoscopic gastric bypass: a systematic review and meta-analysis

Assessment of a novel unidirectional mid-term absorbable barbed suture versus a competitor barbed suture for vaginal cuff closure after gynaecology surgery, study protocol of a randomized controlled trial - BARHYSTER

BACKGROUND

Total laparoscopic hysterectomy (TLH) is nowadays the standard to treat benign and malignant disease occurring in the uterus, but the number of robotic-assisted surgeries is increasing worldwide. To facilitate the handling of sutures in a bi- and tri-dimensional plane, a new type of suture material has been developed, named barbed sutures, which are in use in different indications. In comparison to conventional suture materials, the barbs anchor the suture in the tissue, provide tissue approximation and prevent slippage without the need for knot tying. Several meta-analyses and systematic reviews have shown that they are safe and efficient. The current study investigates the clinical outcome of a novel unidirectional mid-term absorbable barbed suture which differs in its configuration from other barbed sutures. The collected data will be prospectively compared to the results of a competitor's unidirectional mid-term absorbable barbed suture and retrospectively to the findings reported for conventional sutures after hysterectomy in the literature.

METHODS

An international, randomised, multicentric, single-blinded design was chosen. A total of 132 patients will be included receiving randomly either the novel unidirectional barbed suture versus the competitor unidirectional barbed suture in a 3:1 ratio. Both suture materials will be applied to close the vaginal cuff after laparoscopic hysterectomy and the time for suturing is the primary endpoint. As secondary objectives, the following parameters will be collected and compared in both suture groups: intraoperative handling of the suture material, quality of life using the Female Sexual Function Index (FSFI), patient satisfaction, pain, and complications occurring in the short-term and long-term follow-up. For each patient, the study lasts 6 months after surgery.

DISCUSSION

This study will assess the clinical performance of a novel unidirectional mid-term absorbable barbed suture material for the first time in gynaecology surgery and, to our knowledge, it will be the second largest RCT performed so far in total laparoscopic hysterectomy using unidirectional mid-term absorbable barbed suture materials.

TRIAL REGISTRATION

The study was prospectively registered before the enrolment of the first patient. Registration was performed under www.

CLINICALTRIALS

gov , NCT06024109. Registered on 15 August, 2023.

The current role of barbed sutures in fascial closure of ventral hernia repair: a multicenter study using the abdominal core health quality collaborative database

BACKGROUND

Barbed sutures (BS) have been increasingly used in the last two decades across surgical disciplines but little is known about how widespread their adoption has been in ventral hernia repair (VHR). The aim of this study was to document the use of barbed sutures in VHR in a multicenter database with associated clinical and patient-reported outcomes.

METHOD

Prospectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent VHR with fascial closure from 2020 to 2022. A univariate analysis compared patients with BS against non-barbed sutures (NBS) across the preoperative, intraoperative, and postoperative timeframes including patient-reported outcomes concerning quality of life and pain scores.

RESULTS

A total of 4054 patients that underwent ventral hernia repair with BS were compared with 6473 patients with non-barbed sutures (NBS). Overall, BS were used in 86.2% of minimally invasive ventral hernia repairs and about 92.2% of robotic surgery compared to only 9.6% of open procedures. Notable differences existed in patient selection, including a higher BMI (32 vs 30.5; p < 0.001), more incisional hernias (63.3% vs 51.1%; p < 0.001), wider hernias (4 cm vs 3 cm; p < 0.001), and higher ASA score (p < 0.001) in patients with BS. Outcomes in patients with BS included a shorter length of stay (mean days; 1.4 vs 2.4; p < 0.001), less SSI (1.5% vs 3.6%; p < 0.001), while having similar SSO (7.6% vs 7.3%; p = 0.657), readmission (3.0 vs 3.2; p = 0.691), and reoperation (1.5% vs 1.45%; p = 0.855), at a longer operative time (p < 0.001). Hernia-specific questionnaires for quality of life (HerQLes) and pain in patients with BS had a worse preoperative score that was later matched and favorable compared to NBS (p = 0.048). PRO concerning hernia recurrence suggest around 10% at two years of follow-up (p = 0.532).

CONCLUSION

Use of barbed sutures in VHR is widespread and highly related to MIS. Outcomes from this multicenter database cannot be reported as superior but suggest that barbed sutures do not have a negative impact on outcomes.

Comparisons of laparoscopic and robotic pancreaticoduodenectomy using barbed and conventional sutures for pancreaticojejunostomy: a propensity score matching study

BACKGROUND

There are limited data on the effect of different sutures and surgical approaches on the quality of pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy (MIPD). This study compares the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) between the use of barbed sutures (BSs) and conventional sutures (CSs).

METHODS

A retrospective cohort study was conducted on 253 consecutive patients who had undergone MIPD from July 2016 to April 2023. Patients were excluded if conversion to open surgery or open anastomosis was necessary. 220 patients were enrolled and divided into BS (n = 148) and CS (n = 72) groups. After 1:1 propensity score matching (PSM), 67 cases remained in each group. Univariate and multivariate analyses identified factors associated with CR-POPF. Comparisons were also made between laparoscopic (LPD) and robotic (RPD) pancreaticoduodenectomy.

RESULTS

After PSM, BSs were associated with significantly lower rates of CR-POPF (7.5 vs. 22.4%, P = 0.015) and severe complications (Clavien-Dindo ≥ III) (7.5vs. 19.4%, P = 0.043). No significant differences were found in operative time, length of postoperative hospital stay, or other major morbidities. Multivariate analyses revealed BMI ≥ 22 kg/m2 (OR = 5.048, 95% CI: 1.256-20.287, P = 0.023) and the use of BSs (OR = 0.196, 95% CI: 0.059-0.653, P = 0.008) as the independent predictors of CR-POPF. There were no significant differences in postoperative outcomes between the LPD and RPD groups, but RPD was associated with significantly shorter operative time (402.8 min vs. 429.4 min, P = 0.015).

CONCLUSIONS

In conclusion, using BSs for PJ during MIPD is feasible and has the potential to reduce CR-POPF and severe complications.

Omentopexy versus no omentopexy in sleeve gastrectomy: an updated systematic review and meta-analysis

Laparoscopic sleeve gastrectomy with omentopexy (O-LSG) has been compared to laparoscopic sleeve gastrectomy with no-omentopexy (NO-LSG) in terms of postoperative outcomes and one-year anthropometric results. This systematic review with meta-analysis aimed to compare the utility of omentopexy in sleeve gastrectomy. We performed a systematic review with meta-analysis according to PRISMA 2020 and AMSTAR 2 guidelines. We included studies that systematically searched electronic databases and compared the O-LSG with the NO-LSG conducted through 1st March 2023. The bibliographic research yielded 13 eligible studies. These studies included 5514 patients. The O-LSG is associated with lower leakage (OR = 0.22; 95% CI [0.08, 0.55], p = 0.001), bleeding (OR = 0.33; 95% CI [0.19, 0.57], p < 0.0001), vomiting (OR = 0.50; 95% CI [0.28, 0.89], p = 0.02), twist (OR = 0.09; 95% CI [0.02, 0.39], p = 0.001), and shorter hospital stay (MD = - 0.33; 95% CI [- 0.61, - 0.05], p = 0.02) compared with NO-LSG. The O-LSG is associated with longer operative time (MD = 8.15; 95% CI [3.65, 12.64], p = 0.0004) than the NO-LSG. There were no differences between the two groups in terms of postoperative GERD (OR = 0.53; 95% CI [0.27, 1.02], p = 0.06), readmission (OR = 0.60; 95% CI [0.27, 1.37], p = 0.23), and one-year total weight loss (MD = 2.06; 95% CI [- 1.53, 5.65], p = 0.26). In the subgroup analysis including only RCTs, postoperative GERD was lower in the O-LSG (OR = 0.26; 95% CI [0.11, 0.63], p = 0.003). Our systematic review and meta-analysis concluded that omentopexy in sleeve gastrectomy is feasible and safe It reduced leakage, bleeding, and twist. It probably increased the operative time. It may reduce vomiting, GERD, and hospital stay. We don't know if it led to an additional readmission rate or one-year total weight loss.Registration The protocol was registered in PROSPERO with the ID CRD42022336790.

Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study

INTRODUCTION

Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis.

METHODS

All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread.

RESULTS

Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029).

CONCLUSIONS

Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.

A fully stapled technique for gastrojejunal anastomosis creation in robotic Roux-en-Y gastric bypass

PURPOSE

The purpose of this paper is to showcase a fully stapled approach to creating a gastrojejunostomy during a robot-assisted Roux-en-Y gastric bypass.

METHODS

We utilize two robotic 12-mm ports, two robotic 8-mm ports, and one 8-mm assistant port. The tools used are a fenestrated bipolar forceps, vessel sealer, cadiere grasper, needle driver, and a robotic stapler. After the partial gastrectomy, the roux limb is brought up to the gastric pouch where monopolar scissors are used to create a gastrotomy and enterotomy. The gastrotomy is made just above the staple line of the gastric pouch. The enterotomy is created 2 cm distal to the roux limb's staple line. The stapler is inserted into both the gastrotomy and enterotomy to create the common channel. A 2-0 vicryl suture is used to place four interrupted sutures across the remaining enterotomy in full thickness bites. An endoscope or Visigi bougie is advanced across the anastomosis into the roux limb before the final suture. The tails of the most lateral and medial sutures are grasped and lifted towards the abdominal wall. The stapler is advanced over the approximated enterostomy while holding tension with the suture tails. The stapler is fired transversely across the suture line to seal the gastrojejunostomy. The staple line may be oversewn with silk sutures. A leak test is performed prior to completing the reconstruction with the jejunojejunostomy.

CONCLUSIONS

A fully stapled technique of anastomosis creation may reduce operative time, standardizes the process for reproducibility, and increases consistency across operators and patients.