A simple and effective technique for laparoscopic gastrorrhaphy: modified Graham’s patch with barbed suture

Abstract

Introduction Peptic ulcers are caused by unbalanced acid production, and proton pump inhibitors (PPIs) in recent decades have helped to treat peptic ulcers effectively. Meanwhile, the incidence of perforated peptic ulcer (PPU) persists and has a high mortality rate if there is no adequate management. Primary closure with a modified Graham’s patch was well performed in early detected PPU with a small size < 2 cm. A laparoscopic approach for PPU was prescribed for decades with proven feasibility and safety. We introduced an effective technique combined with barbed suture and modified Graham’s patch, which can significantly reduce the surgical time without significantly increasing morbidity and mortality compared with traditional interrupted suture. Patients and method We retrospectively collected data from January 2014 to December 2020 in Keelung Change Gung Memorial Hospital, and a total of 154 patients receiving laparoscopic repair of PPU were included. There were 59 patients in the V-loc group (V group) and 95 patients in the laparoscopic primary repair group (P group). Results The V group had a significantly shorter operation time than the P group (96.93 ± 22.14 min vs. 123.97 ± 42.14, P < 0.001). Ten patients suffered from morbidity greater than the Clavien‒Dindo classification 4 (5 from V group, and 5 from P group). Three patients with leakage were reported. Two patients were in the V group, and one patient was in the P group (p = 0.432). Conclusion Laparoscopic repair with barbed suture and modified Graham’s patch provides a simple and effective technique in the management of acute abdomen. This technique can be easily performed by experienced surgeons and trainees in minimally invasive surgery without affecting patient safety.

Laparoscopic Treatment of Perforated Peptic Ulcer: A Propensity Score-Matched Comparison of Interrupted Stitches Repair versus Knotless Barbed Suture

“…In contrast with previous research, our study showed comparable operative time using knotless barbed sutures compared to conventional interrupted stitches [ 18 , 19 , 20 ]. One possible explanation could be the laparoscopic skill of the surgeons.…”

“…The successful implementation of laparoscopic PPU repair is also owed to the development of new suture materials, notably knotless barbed sutures [ 20 ]. Despite some drawbacks like higher costs and irreversibility, knotless barbed sutures have gained acceptance in general surgery [ 49 , 50 ].…”

“…Concerning leaks, the present analysis did not show any difference between the two gastrorrhaphy techniques. Chou et al recently recorded a slightly increased leakage rate in the barbed suture group and hypothesised that the key point of the problem was leakage at the corner of the suture [ 20 ]. Effectively barbed sutures often need a couple of bites to fix the wire before addressing the defect to close.…”

“…Accordingly, they modified their procedure, focusing on starting the suture at the perforation’s apex as much as possible. Consequently, these adjustments led to a significant decrease in the complications associated with leaks [ 20 ].…”

“…A contributing element to the better results seen in laparoscopic surgery involves the knotless barbed suture. This innovation allows for the avoidance of laparoscopic suture knotting while reducing operative time of gastrointestinal surgery including PPU repair [ 18 , 19 , 20 ].…”