Iatrogenic Intestinal and Mesenteric Injuries with Small Bowel Volvulus Following Use of Barbed Suture During Laparoscopic Myomectomy

Knotless barbed sutures are an innovative suturing material that can facilitate laparoendoscopic operations. The purpose of this study is to examine the available evidence on the application of barbed sutures on both laparoscopic and robotic operations in the field of gynecologic surgery. A systematic search was performed in PubMed, Scopus, and Cochrane databases. In total, 1991 patients were included in the study. The duration of closure with knotless suture ranged from 3.9 to 13 minutes, which was less than the use of conventional suture in every study. The duration of suturing was significantly less in the barbed suture group during hysterectomy, the mean difference between the observed groups was 2.41 minutes per operation (95% confidence interval, 1.23-3.59) whereas in myomectomy there was no statistically significant difference between compared groups. Concerning the estimated blood loss and the presence of major bleeding in hysterectomy, no statistical difference between the 2 groups was observed, while the estimated blood loss in myomectomy was found to be statistically significant (P = .04). Regarding the dehiscence of vaginal cuff in hysterectomy, no statistically significant difference was observed (1031 patients, odds ratio = 1.63; 95% confidence interval = 0.37-7.25). The complete absence of knots, the even distribution of tissue strength along the wound, and the reduction of operation time are the main advantages of this type of sutures. Additional clinical trials of higher methodological quality are necessary to further clarify suturing advantages and postoperative outcomes of the barbed sutures.

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“…[21][22][23][24] Sixteen studies referred to laparoscopic cases while 3 studies to robotic cases. In total, 1991 patients were included.…”

Section: Resultsmentioning

confidence: 99%

The Role of Knotless Barbed Suture in Gynecologic Surgery

2014

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“…Other studies have indicated that barbs can cause small bowel injury [21] and that within 30 days after total laparoscopic hysterectomy, small bowel obstruction can develop [22], possibly because the laparoscope can disrupt the suture line, allowing the barbs to get caught in the digestive tract and greater omentum. In addition, barbs left exposed outside the uterus after the suture thread is cut can become entangled in the digestive tract and cause small bowel obstruction, especially when the suture thread is tensed before being cut, drawing the thread into the myometrium.…”

Section: Discussionmentioning

confidence: 99%

Long unidirectional barbed suturing technique with extracorporeal traction in laparoscopic myomectomy

et al. 2014

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BackgroundMyomectomy is now often performed laparoscopically rather than by laparotomy to alleviate the risk of postoperative adhesions and reduce postoperative pain. However, intracorporeal knot-tying under direct laparoscopy is difficult and requires proficiency. We conducted a retrospective study comparing the results of a long unidirectional barbed suturing technique (with V-Loc180 suture) and the results of conventional suturing as applied to laparoscopic myomectomy.MethodsIn women who underwent laparoscopic myomectomy in our university hospital between January 2011 and April 2013, uninterrupted suturing of 2 or more layers was performed. These women were divided into 2 groups according to the method of suturing: those in whom standard absorbable sutures were used (group P, n =42) and those in whom our suturing technique was used (group V, n =41). Patient characteristics and surgical variables were compared between the 2 groups.ResultsNo significant between-group difference was observed in age (p = .975), body mass index (p = .778), GnRHa administration (p = .059), intraoperative vasopressin dose (p = .364), intraoperative blood loss (73.8 ± 64.1 vs. 59.3 ± 54.0 mL, respectively; p = .199), myoma mass (212.6 ± 133.3 vs. 208.3 ± 198.4 g, respectively; p = .134), ΔHb (p = .517), or postoperative hospital stay (p = .314). Operation time (mean ± SD) was significantly shorter for group V (71.2 ± 22.9 minutes; range, 28.0–110.0 minutes; p < .001) than for group P (94.4 ± 27.2 minutes; range, 53.0–165.0 minutes). No patient required intraoperative transfusion or conversion to laparotomy.ConclusionsOur suturing technique exploits the features of unidirectional barbed sutures and can be used in the same way as the conventional method when performing continuous suturing for laparoscopic myomectomy. Our data suggest that operation time can be reduced by as much as 25% with this new technique.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2482-14-84) contains supplementary material, which is available to authorized users.

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“…TAPP repair invariably requires peritoneal closure because the bowel may adhere to the exposed prosthetic mesh. However, use of the barbed suture is also associated with the risk of small bowel entrapment when the free end of the thread is cut long; potentially severe postoperative complications, such as intestinal obstruction, have been reported in such circumstances (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). To prevent these complications, the barbed suture may be additionally trimmed and buried using either absorbable sutures, or surgical clips (19).…”

Section: Discussionmentioning

confidence: 99%