Safety and efficacy of barbed suture for gastrointestinal suture: a prospective and randomized study on obese patients undergoing gastric bypass.

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Abstract

Laparoscopic intracorporeal suturing and knot tying for anastomosis are considered the most difficult laparoscopic skills to master. The aim of this study was to establish the safety and efficacy of barbed suture for intestinal sutures to close the gastrojejunal anastomosis in obese patients undergoing gastric bypass.

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Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement.

(1992)

The National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity brought together surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals as well as the public to address: the nonsurgical treatment options for severe obesity, the surgical treatments for severe obesity and the criteria for selection, the efficacy and risks of surgical treatments for severe obesity, and the need for future research on and epidemiological evaluation of these therapies. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel recommended that (1) patients seeking therapy for severe obesity for the first time should be considered for treatment in a non-surgical program with integrated components of a dietary regimen, appropriate exercise, and behavioral modification and support, (2) gastric restrictive or bypass procedures could be considered for well-informed and motivated patients with acceptable operative risks, (3) patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, and nutritional expertise, (4) the operation be performed by a surgeon substantially experienced with the appropriate procedures and working in a clinical setting with adequate support for all aspects of management and assessment, and (5) lifelong medical surveillance after surgical therapy is a necessity. The full text of the consensus panel's statement follows.

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Evaluation of a novel technique for wound closure using a barbed suture.

Gordon Mills, M Paglia, M L Feldstein … (2006)

Suture knots present several disadvantages in wound closure, because they are tedious to tie and place ischemic demands on tissue. Bulky knots may be a nidus for infection, and they may extrude through skin weeks after surgery. Needle manipulations during knot-tying predispose the surgeon to glove perforation. A barbed suture was developed that is self-anchoring, requiring no knots or slack management for wound closure. The elimination of knot tying may have advantages over conventional wound closure methods. This prospective, randomized, controlled trial was designed to show that the use of barbed suture in dermal closure of the Pfannenstiel incision during nonemergent cesarean delivery surgery produces scar cosmesis at 5 weeks that is no worse than that observed with conventional closure using 3-0 polydioxanone suture. Cosmesis was assessed by review of postoperative photographs by a blinded, independent plastic surgeon using the modified Hollander cosmesis score. Secondary endpoints included infection, dehiscence, pain, closure time, and other adverse events. The study enrolled 195 patients, of whom 188 were eligible for analysis. Cosmesis scores did not significantly differ between the barbed suture group and the control group. Rates of infection, dehiscence, and other adverse events did not significantly differ between the two groups. Closure time and pain scores were comparable between the groups. The barbed suture represents an innovative option for wound closure. With a cosmesis and safety profile that is similar to that of conventional suture technique, it avoids the drawbacks inherent to suture knots.

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Abdominoplasty with progressive tension closure using a barbed suture technique.

Jeremy Warner, Karol A. Gutowski (2015)

Seroma and skin necrosis are potential complications following abdominoplasty. Many methods have been employed to prevent these complications, including the progressive tension suture technique. The authors evaluate a progressive tension suture technique modification using the Quill barbed suture (Angiotech Pharmaceuticals, Inc., Vancouver, British Columbia, Canada) to determine whether the original benefits of this classic technique can be obtained in a shorter operative period. The modified progressive tension closure technique with Quill sutures uses barbed sutures to plicate the abdominoplasty flap to the underlying abdominal wall. The placement of the suture is performed with a running suture technique and provides progressive tension, resulting in minimal tension along the incision line. Data from 58 patients undergoing abdominoplasty using this technique are examined, including time to insert the sutures and complications such as seroma, hematoma, and skin necrosis. There was a marked reduction in the time necessary to perform the modified progressive tension suture technique using barbed sutures compared to previously published data. The authors' average time was nine minutes to complete plication of the entire abdominal flap. One seroma is reported, which was resolved with one aspiration. No hematomas or skin necrosis complications are reported. Using barbed sutures to perform progressive tension suture closure in abdominoplasty is a safe and effective way to considerably reduce operative time and retain all of the benefits of the original progressive tension suture technique.