Barbed vs conventional sutures in bariatric surgery: a propensity score analysis from a high-volume center

Abstract

The use of barbed sutures for constructing an anastomosis is favoured by a few bariatric surgeons as compared to conventional sutures. The aim of this study is to assess safety and efficacy of barbed sutures to close the gastric pouch-jejunal anastomosis (GPJA) in laparoscopic gastric bypass (Roux-en-Y gastric bypass-RYGB, and One-Anastomosis gastric bypass-OAGB) using propensity score-matching (PSM) analysis. A retrospective analysis of patients who underwent primary laparoscopic gastric bypasses between January 2012 and December 2017 was performed. Patients were divided into two different groups (RYGB-G and OAGB-G). PSM analysis was performed to minimize patient selection bias between the two types of sutures (barbed-BS and conventional-CS) in each group. A total of 808 patients were reviewed. After PSM, 488 (244 BS vs 244 CS) patients in RYGB-G and 48 in OAGB-G (24 BS vs 24 CS) patients were compared. Median operative time was significantly shorter (p < 0.001) for BS in RYGB-G. In OAGB-G, BS were associated with a shorter operative time, although no significant difference was observed (p = 0.183). Post-operative hospital stay was significantly shorter for BS in both the groups (p < 0.001). Post-operative 30th-day complications were comparable: no leakage or bleeding of GPJA was observed in BS groups. At median follow-up of 28.78 months, no late complications were observed. Barbed sutures appear to be effective to close GPJA during gastric bypass and as safe as conventional suture. Further studies are necessary to draw definitive conclusions.

Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis

“…The literature search identified nine studies that were suitable for inclusion in the analysis (two randomised trials, 14,15 six cohort studies, [16][17][18][19][20][21] and one population based cohort study). 22 Figure 1 demonstrates the preferred reporting items for systematic reviews and meta-analyses flowchart for the literature search.…”

Barbed suture and gastrointestinal surgery. A retrospective analysis

“…In the current literature, the safety and efficacy of barbed suture has been demonstrated in many surgical fields [8, 9, 10, 11, 12, 13], but less is known in digestive surgery, where its efficacy and safety has been demonstrated mainly in bariatric surgery [36, 37, 38].…”

Use of barbed sutures in robotic bariatric bypass surgery: a single-center case series

“…Another possible advantage of using the barbed suture is a gain in time; however, we cannot judge this due to the lack of a control group. Vidarsson et al 2017 [7] and Pennestri et al 2018 [8] describe a significant time gain using barbed sutures in laparoscopic RYGB procedures, whereas Gys et al 2017 found significant time benefit only for the anastomosis itself, not for the total procedure time [6]. Compared to a historical laparoscopic RYGB cohort [12], the mean operative time with the surgical robot was about 10 min shorter.…”

“…Self-fixing barbed suture material makes the laparoscopic knot obsolete and promises a constant thread tension after a single tightening of the barbed suture material. Studies have proven the safety and efficacy of this special suture material in laparoscopy [5–8]. Gys et al reported a comparable operative time with a shorter anastomosis time in a randomized controlled study [5, 6], while Vidarsson et al evaluated a cohort of 25,000 patients and found indications of a shortening of the total operating time, also with comparable safety [7].…”

“…Gys et al reported a comparable operative time with a shorter anastomosis time in a randomized controlled study [5, 6], while Vidarsson et al evaluated a cohort of 25,000 patients and found indications of a shortening of the total operating time, also with comparable safety [7]. Recently, Pennestri et al also described a significantly shorter median operative time in laparoscopic RYGB using the barbed suture in a retrospective analysis [8].…”