Routine Use of v-Lock® Suture for Bariatric Anastomosis Is Safe: Comparative Results From Consecutive Case Series

Abstract

Background: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. Aim: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. Methods: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. Results: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). Conclusion: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.

Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study

“…In literature, only few authors compared different suture threads [50,51] for gastrointestinal closure. Barbed suture has recently been proposed to facilitate laparoscopic suturing, obviating the need for knot tying, and it seems to be considered safe and feasible for enterotomy closure after stapled anastomosis for gastric cancer [52][53][54] or after laparoscopic Roux-en-Y gastric bypass [55][56][57][58]. According to current literature [35,44,54,59,60], in our analysis, we have provided the safety and efficacy of barbed suture.…”

Auxiliary Thread to Tie a Short Thread of a Running Suture

“…When finishing a continuous suture, often a thread segment is too short to be tied. In this situation, the knots are made with the aid of needle holders or hemostatic forceps, but the result may be unsatisfactory 1 , 2 , 3 . Another option is to fix it with another thread, which is tied with the short thread, increasing the cost of the operation.…”