Immediate Effects of the Self-Retaining Barbed Suture Material Application for Gastrojejunostomy During Mini Gastric Bypass Laparoscopic Surgery

Abstract

Background. The safety of self-retaining barbed suture material application when closing wounds of hollow organs and forming anastomoses remains controversial. Data on the use of self-retaining barbed suture material at the stage of a single anastomosis formation during mini gastric bypass laparoscopic surgery (mini gastric bypass - MGB) in the treatment of morbid obesity is scarce and includes both examples of suturing a technological hole after the implementation of a hardware technique, and totally hand-sewn intracorporeal knotless formation of a gastrojejunostomy.The aim of the study was to evaluate the immediate effects of single-row continuous sutures performed with self-retaining barbed unidirectional suture material for intracorporeal hand-sewn gastrojejunostomy during MGB.Methods. The study included 116 patients with grade II-III obesity who underwent MGB. The total duration of operations and the duration of the gastrojejunostomy stage, the volume of intraoperative blood loss, the frequency and severity of intra- and postoperative complications were prospectively studied in accordance with the unified classifications of Satava-Kazaryan and Accordion, respectively. The first group consisted of 56 patients; a conventional synthetic (polydioxanone) monofilament suture material was used for hand-sewn gastrojejunostomy in patients of this group. The second group consisted of 60 patients; gastrojejunostomy was performed with single-needle unidirectional self-retaining barbed absorbable polyester monofilaments in patients of this group. The study groups did not differ significantly in demographic characteristics, body mass index (BMI), the nature of comorbid pathology and the frequency of previous operations.Results. The use of unidirectional self-retaining barbed suture material for a hand-sewn intracorporeal single-row gastrojejunostomy in MGB was accompanied by a significant reduction in the total duration of interventions due to a reduced gastrojejunostomy stage if compared with the use of conventional synthetic monofilaments. The median volume of blood loss during operations did not exceed 50 ml and had no significant differences between groups. Intraoperatively, in patients of the study groups there were registered only complications of the first degree of severity, according to the Satava-Kazaryan classification, with a frequency of 6.7-8.9% (p = 0.737). In the postoperative period, the development of minor complications (first severity of the Accordion system) occurred in 19.6% and 16.7% of patients of the first and second groups, respectively (p = 0.810). The duration of hospital stay was 3.0 (2.5; 3.0) and 2.7 (2.7; 3.0) days in the first and second groups, respectively (р=0,790).Conclusion. The achieved reduced duration of MGB due to the reduced stage of gastrojejunostomy with self-retaining barbed unidirectional suture material, and comparable immediate effects of surgical treatment in patients of the first and second groups demonstrate significant outcomes. Further study is necessary to investigate long-term effects of the knotless suture application for a single anastomosis formation during MGB surgery.