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The Use of Unidirectional Knotless Barbed Suture for Enterotomy Closure in Roux-en-Y Gastric Bypass: a Randomized Comparative Study

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Abstract

Purpose

In this study, we assessed feasibility, safety, and time efficiency of laparoscopic running enterotomy closure for linear stapled Roux-en-Y Gastric Bypass (RYGB) using unidirectional barbed sutures (Stratafix™ 2/0- Ethicon).

Materials and Methods

Two hundred patients undergoing laparoscopic RYGB were prospectively randomized regarding running enterotomy closure of the linear stapled gastrojejunal (GJA) and jejunojejunal anastomosis (JJA). Two groups were created: V-group (Vicryl® 2/0—Ethicon) and S-group (Stratafix™ 2/0—Ethicon). Time spent on closing the enterotomies was measured from first needle in until knot and cut (V-group) or last stitch and cut (S-group). If needed, a nonabsorbable “correction” (“c”; in order to close a small hiatus at the anastomosis) or hemostatic (“h”) stitch was made (using a single Prolene® 2/0—Ethicon).

Results

Average total procedure time was similar (S-group 1:01:22, V-group 1:00:44, P = 0.340). Closure of the enterotomy (GJA) was significantly shorter in the S-group (07:41 min versus 08:13 min in the V-group, P = 0.005). Extra stitches (GJA) were performed in 33 patients (16.5%): 3 (h) and 20 (c) in the V-group and 1 (h) and 9 (c) in the S-group. Four patients in the V-group suffered from postoperative intraluminal bleeding (3 self-limiting, 1 underwent endoscopic clipping). In the S-group, 1 patient suffered from leakage at the vertical transected staple line of the stomach.

Conclusions

The use of unidirectional barbed sutures for running enterotomy closure after linear stapled RYGB is feasible and safe. Significant time benefit was seen regarding the closure of the GJA. Fewer additional stitches were necessary and postoperative intraluminal bleeding was less encountered.

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Correspondence to Ben Gys.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Gys, B., Gys, T. & Lafullarde, T. The Use of Unidirectional Knotless Barbed Suture for Enterotomy Closure in Roux-en-Y Gastric Bypass: a Randomized Comparative Study. OBES SURG 27, 2159–2163 (2017). https://doi.org/10.1007/s11695-017-2628-3

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  • DOI: https://doi.org/10.1007/s11695-017-2628-3

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