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Berrevoet F, van Cauteren L, Gunja N, Danker WA, Schmitz ND, Tomaszewski J, Stern L, Chandak A. Clinical outcomes of triclosan-coated barbed suture in open hernia repair: a retrospective cohort study. Hernia 2024:10.1007/s10029-024-03012-0. [PMID: 38609582 DOI: 10.1007/s10029-024-03012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/01/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE We assessed clinical outcomes of patients undergoing open hernia repair using STRATAFIX™ Symmetric, a barbed triclosan-coated suture (TCS; Ethicon), versus conventional polydioxanone suture (PDS) for abdominal wall closure. METHODS This single-center retrospective cohort study identified patients undergoing hernia repair. The site used PDS from 2013 to 2016 and switched exclusively to barbed TCS in 2017. Outcomes were assessed at 30, 60, and 90 days. Multivariate regression analyses and Cox proportional hazards models were used. RESULTS Of 821 hernia repairs, 446 used barbed TCS and 375 used conventional PDS. Surgical site infections (SSIs) were significantly less frequent with barbed TCS (60 days, 5.9% vs. 11.4%; P = 0.0083; 90 days, 5.9% vs. 11.7%; P = 0.006) and this remained consistent after multivariate adjustment (60 days, OR [95% CI]: 0.5 [0.3-0.9]; 90 days, 0.5 [0.3-0.9]). Among patients with SSI, deep SSIs were less frequent with barbed TCS (60 days, 9.1% vs. 35.7%; P = 0.022; 90 days, 9.1% vs. 34.9%; P = 0.0252). Barbed TCS significantly reduced the risk of perioperative complications (HR [95% CI]: 0.5[0.3-0.8]; P = 0.0058). Hospital length of stay was 2.5 days shorter with barbed TCS (mean [95% CI]: 5.7[4.9-6.6] vs. 8.2[7.3-9.1] days; P < 0.0001). No differences in reoperation rate over time were observed by type of suture (HR[95% CI]:1.3 [0.5-3.4]; P = 0.4793). CONCLUSIONS This study showed that patients who underwent open hernia repair appeared to recover equally well regardless of the suture type. In addition, the use of barbed TCS was associated with significantly reduced risk of perioperative complications and hospital length of stay.
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Affiliation(s)
- F Berrevoet
- University Hospital Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - L van Cauteren
- University Hospital Gent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - N Gunja
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | - W A Danker
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | - N-D Schmitz
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | | | - L Stern
- Certara, 100 Overlook Center, Suite 101, Princeton, NJ, 08540, USA
| | - A Chandak
- Certara, 100 Overlook Center, Suite 101, Princeton, NJ, 08540, USA.
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Comparison of Mesh and Barbed Suture for Laparoscopic Nephrosplenic Space Ablation in Horses. Animals (Basel) 2021; 11:ani11041096. [PMID: 33921312 PMCID: PMC8069580 DOI: 10.3390/ani11041096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Nephrosplenic space (NSS) ablation has been demonstrated to be an effective technique for prevention of left dorsal displacement of the large colon and multiple laparoscopic techniques, among which ablation with mesh or with a barbed suture, have been proposed. Our objective was to compare two laparoscopic techniques for closure of the NSS in twenty-eight horses diagnosed with nephrosplenic entrapment. Medical records of horses that had laparoscopic NSS ablation in two referral centers between 2017-2019 were retrieved. Duration of surgery, complications, and short- and long-term follow-up information were collected and compared. Costs were also calculated and compared. All horses met the inclusion criteria: 9 had NSS ablation with a mesh implant (group M), 19 with barbed suture material (group B). One horse in group B had recurrent colic after discharge. At control laparoscopy after 5 months, the NSS resulted in still not being ablated because of a failure of the suture. In group M, three horses had recurrent colic. One was successfully treated medically, one died of unknown causes and the third required a second laparoscopic suturing at 3-6 months because of failure of the mesh implant. The mean time of surgery and costs were lower in group B compared to group M. The barbed suture technique was faster, more cost-effective and had a lower complication rate than the mesh implant.
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Velotti N, Manigrasso M, Di Lauro K, Vertaldi S, Anoldo P, Vitiello A, Milone F, Musella M, De Palma GD, Milone M. Barbed suture in gastro-intestinal surgery: A review with a meta-analysis. Surgeon 2021; 20:115-122. [PMID: 33820730 DOI: 10.1016/j.surge.2021.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/06/2020] [Accepted: 02/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The laparoscopic approach is a very popular technique for many gastrointestinal operations and barbed sutures may improve the difficulties of intracorporeal anastomosis by eliminating the need for knot tying. The aim of this systematic review with a meta-analysis is to explore literature to establish the security profile of barbed suture compared with conventional laparoscopic sutures. MATERIALS AND METHODS A systematic search was performed in all electronic databases (PubMed, Web of Science, Scopus, EMBASE) and 12 studies were included in the analysis, involving 27,133 patients, whereof 3372 cases (patients undergone barbed suture usage) and 23,761 controls (patients undergone conventional suture usage). We found 3 studies discussing differences between barbed and conventional sutures in colorectal surgery and 8 studies presenting results in bariatric surgery, both in Roux-en-y gastric bypass and Mini Gastric/One Anastomosis Gastric Bypass. RESULTS We found comparable rate of leaks, bleedings and stenosis. The meta-regression analysis demonstrated that, both in case of bariatric and colorectal surgery, the demographic characteristic of patients and the oncological features of neoplasms did not impact of these findings. As expected, operative time is significantly shorter when barbed suture is used. CONCLUSION Our analysis on current literature define an acceptable security profile for barbed suture with effective results particularly in terms of shorter operative time.
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Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Katia Di Lauro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Pietro Anoldo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonio Vitiello
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesco Milone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Chaouch MA, Kellil T, Taieb SK, Zouari K. Barbed versus conventional thread used in laparoscopic gastric bypass: a systematic review and meta-analysis. Langenbecks Arch Surg 2020; 406:1015-1022. [PMID: 32857247 DOI: 10.1007/s00423-020-01979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hand-sewn gastrointestinal anastomosis during laparoscopic gastric bypass (GBP) could be performed using the conventional multifilament suture (CS) or a barbed suture (BS). This systematic review with meta-analysis aimed to assess the advantages and disadvantages of these two anastomosis alternatives. METHODS Bibliographic search for relevant studies was performed, according to the PRISMA guidelines, to perform the systematic review with meta-analysis. RevMan was applied to analyze the data using the random effects size. RESULTS Eight studies were eligible for analysis including 26,340 patients. These patients underwent a single gastric bypass or Roux-en-Y gastric bypass. According to the available data from this systematic review with meta-analysis, BS in GBP ensures similar morbidity rate (OR = 1.04, 95% CI: 0.82 to 1.31, p = 0.74) with shorter operative time (MD = - 7.90, 95% CI: - 12.95 to - 2.84, p = 0.002). BS is similar to CS in terms of anastomotic leak (OR: 1.25, 95% CI: 0.90 to 1.73, p = 0.19), stricture (OR: 0.89, 95% CI: 0.32 to 2.44, p = 0.82), bleeding (OR: 0.62, 95% CI: 0.20 to 1.86, p = 0.39), and hospital stay (MD: 0.04, 95% CI: - 0.28 to 1.86, p = 0.81). On the other way, BS is cheaper than CS. CONCLUSION The majority of studies were retrospectives. One study included the large majority of retained patients; thus then, this comparison should be interpreted with caution. BS and CS in gastrointestinal anastomosis during GBP are feasible and safe. BS is faster and cheaper with similar postoperative outcomes.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia.
| | - Tarek Kellil
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia
| | - Sahbi Khaled Taieb
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia
| | - Khadija Zouari
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia
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Wiggins T, Majid MS, Markar SR, Loy J, Agrawal S, Koak Y. Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. Ann R Coll Surg Engl 2020; 102:153-159. [PMID: 31508982 PMCID: PMC6996435 DOI: 10.1308/rcsann.2019.0106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Anastomosis formation constitutes a critical aspect of many gastrointestinal procedures. Barbed suture materials have been adopted by some surgeons to assist in this task. This systematic review and meta-analysis compares the safety and efficacy of barbed suture material for anastomosis formation compared with standard suture materials. METHODS An electronic search of Embase, Medline, Web of Science and Cochrane databases was performed. Weighted mean differences were calculated for effect size of barbed suture material compared with standard material on continuous variables and pooled odds ratios were calculated for discrete variables. FINDINGS There were nine studies included. Barbed suture material was associated with a significant reduction in overall operative time (WMD: -12.87 (95% CI = -20.16 to -5.58) (P = 0.0005)) and anastomosis time (WMD: -4.28 (95% CI = -6.80 to -1.75) (P = 0.0009)). There was no difference in rates of anastomotic leak (POR: 1.24 (95% CI = 0.89 to 1.71) (P = 0.19)), anastomotic bleeding (POR: 0.80 (95% CI = 0.29 to 2.16) (P = 0.41)), or anastomotic stricture (POR: 0.72 (95% CI = 0.21 to 2.41) (P = 0.59)). CONCLUSIONS Use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding or stricture) compared with standard suture materials.
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Affiliation(s)
- T Wiggins
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - MS Majid
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - SR Markar
- Department of Surgery and Cancer, Imperial College London, UK
| | - J Loy
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - S Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - Y Koak
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
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Beckmann JH, Kersebaum JN, von Schönfels W, Becker T, Schafmayer C, Egberts JH. Use of barbed sutures in robotic bariatric bypass surgery: a single-center case series. BMC Surg 2019; 19:97. [PMID: 31337375 PMCID: PMC6651907 DOI: 10.1186/s12893-019-0563-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Surgical robots are increasingly being used in bariatric surgery. While several studies describe the safety of using barbed sutures in laparoscopic gastric bypass surgery, no reports are available for robotic bariatric procedures. The aim of our article is to determine whether barbed sutures can be used safely in robotic Roux-en-Y bypass (RYGB) surgery. METHODS This was a single-center, single-surgeon case series of RYGB procedures using the da Vinci® Xi Surgical System (Intuitive Surgery, Sunnyvale, CA, USA) in combination with the use of barbed sutures (Stratafix, Ethicon, Johnson & Johnson, Cincinnati, OH, USA). RESULTS Fifty robotic proximal and distal RYGB surgeries were performed. A linear stapled, side-to-side gastrojejunostomy was carried out, whereby the enterotomy was completed with a running resorbable unidirectional barbed suture, Stratafix 2-0. In one case after robotic proximal RYGB, revision surgery was required due to omentum necrosis. Another patient was readmitted due to gastrointestinal bleeding from anastomosis. No anastomotic insufficiencies, no stenoses, or higher-grade complications according to Clavien-Dindo 4a-5 were found. CONCLUSIONS We found that the use of self-fixing barbed sutures in robotic RYGB is safe. The self-fixing suture enables the robotic surgeon to perform a simple continuous suture without the need for recurrent retraction. Although we are the first to report this procedure, we had a low number of cases and no control group; thus, further studies with a higher level of evidence are required.
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Affiliation(s)
- Jan Henrik Beckmann
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Strasse 3, 24105, Kiel, Germany.
| | - Jan-Niclas Kersebaum
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Strasse 3, 24105, Kiel, Germany
| | - Witigo von Schönfels
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Strasse 3, 24105, Kiel, Germany
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Strasse 3, 24105, Kiel, Germany
| | - Clemens Schafmayer
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Strasse 3, 24105, Kiel, Germany
| | - Jan Hendrik Egberts
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Strasse 3, 24105, Kiel, Germany
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The Effectiveness and Safety of Barbed Sutures in the Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2019; 29:1756-1764. [DOI: 10.1007/s11695-019-03744-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gys B, Gys T, Ruyssers M, Lafullarde T. Laparoscopic Linear Stapled Running Enterotomy Closure in Roux-en-Y Gastric Bypass Using Absorbable Unidirectional Barbed Suture (Stratafix® 2/0). Obes Surg 2017; 27:2740-2741. [DOI: 10.1007/s11695-017-2870-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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