Barbed Suture for Gastrointestinal Closure: A Randomized Control Trial

Abstract

In an effort to make laparoscopic suturing more efficient, the V-Loc advanced wound closure device (Covidien, Mansfield, MA) has been produced. This device is a self-anchoring barbed suture that obviates the need for knot tying. The goal of this initial feasibility study was to investigate the use of the barbed suture in gastrointestinal enterotomy closure. A randomized study of 12 pigs comparing enterotomy closure with barbed versus a nonbarbed suture of similar tensile strength was performed. To this end, 25 mm enterotomies were made in the stomach (1 control, 1 treatment), jejunum (2 controls, 2 treatments), and descending colon (1 control, 1 treatment). Animals were killed at 3, 7, and 14 days postoperatively (4 each group) and their gastrointestinal tracts harvested; 6 of the 8 enterotomies from each pig underwent burst strength testing. The remaining 2 were fixed in formalin and sent for histological examination. All 12 pigs survived until they were killed without any major complications. Enterotomy closure with barbed suture revealed adhesion scores, burst strength pressures, and histology scores that were similar to those for the control. Jejunal closures resulted in 6 failures at 7 days (3 control, 3 barbed) and 4 failures at 14 days (2 control, 2 barbed). The barbed suture significantly reduced suturing time in the stomach, jejunum, and colon. The V-Loc wound closure device appears to offer comparable gastrointestinal closure to 3-0 Maxon while being significantly faster. Further studies with V-Loc are required to assess its use in laparoscopic surgery.

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

“…Recently, an absorbable unidirectional barbed suture has become available (V-Loc™180, Covidien, Mansfield, MA) ( Figure-1). This suture has been used for skin and soft tissue closures, gynecologic procedures, and bowel anastomosis in a porcine model (6)(7)(8). Anastomoses using standard monofilament for running closure requires frequent re-tightening, with some surgeons relying on the assistant to follow the suture to maintain tension.…”

Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair

“…To date, there have been no suitable devices for peritoneal closure for beginners. V-Loc has been available only recently; therefore, only a few reports on intra-abdominal usage are available [5] . In the present study, we investigated the use of V-Loc to assess the potential simplification of the technically difficult peritoneal closure in herniorrhaphy.…”

Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-LOC180 suture

“…[9][10][11] Subsequent studies on porcine enteric anastomoses have demonstrated closure equivalence with maxon (monofilament polyglyconate), but with faster anastomosis times. 12 Since the initial porcine study by Weld and colleagues, which assessed self-anchoring suture (SAS) material for urinary tract reconstruction, two recent publications have emerged assessing barbed suture for RARP VUA demonstrating feasibility and increased efficiency. 13,14 These small series, however, used separate sutures for PR and VUA.…”