Bowel obstruction due to entanglement with unidirectional barbed suture following laparoscopic myomectomy

Knotless barbed sutures are an innovative suturing material that can facilitate laparoendoscopic operations. The purpose of this study is to examine the available evidence on the application of barbed sutures on both laparoscopic and robotic operations in the field of gynecologic surgery. A systematic search was performed in PubMed, Scopus, and Cochrane databases. In total, 1991 patients were included in the study. The duration of closure with knotless suture ranged from 3.9 to 13 minutes, which was less than the use of conventional suture in every study. The duration of suturing was significantly less in the barbed suture group during hysterectomy, the mean difference between the observed groups was 2.41 minutes per operation (95% confidence interval, 1.23-3.59) whereas in myomectomy there was no statistically significant difference between compared groups. Concerning the estimated blood loss and the presence of major bleeding in hysterectomy, no statistical difference between the 2 groups was observed, while the estimated blood loss in myomectomy was found to be statistically significant (P = .04). Regarding the dehiscence of vaginal cuff in hysterectomy, no statistically significant difference was observed (1031 patients, odds ratio = 1.63; 95% confidence interval = 0.37-7.25). The complete absence of knots, the even distribution of tissue strength along the wound, and the reduction of operation time are the main advantages of this type of sutures. Additional clinical trials of higher methodological quality are necessary to further clarify suturing advantages and postoperative outcomes of the barbed sutures.

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“…[21][22][23][24] Sixteen studies referred to laparoscopic cases while 3 studies to robotic cases. In total, 1991 patients were included.…”

Section: Resultsmentioning

confidence: 99%

“…22,23,26 Events of intestinal obstruction related to the presence of barbed suture might also be avoided if the free edge is cut adequately short in order to prevent the entrapment of the intestine.…”

Section: Discussionmentioning

confidence: 98%

The Role of Knotless Barbed Suture in Gynecologic Surgery

2014

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“…Indeed, if the filaments have not been cut near the tissue at the end of the suture, the remaining portion might adhere to the intestinal wall, leading to an impairment of bowel function, vascular lesion, and intestinal dilatation. Cutting barbed filament short enough should reduce these risks [26, 31, 39-41]. Nevertheless, Einarsson et al [42] showed that the risk of postoperative abdominal adhesions is similar to that which prevails after the use of conventional and barbed sutures.…”

Section: Discussionmentioning

confidence: 99%

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Gardella

Dominoni

Iacobone

et al. 2018

Gynecol Obstet Invest

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Background: This work analyzes the feasibility and effectiveness of barbed suture during laparoscopic myomectomy. Methods: Eight works have been carefully examined for the meta-analysis from all papers published online until November 2017. Results: Barbed suture proved to be superior to traditional suture technique in blood loss in laparoscopic myomectomy (Standardized Mean Difference [SMD] –0.650, 95% CI –1.420 to –0.119, p = 0.098, test for heterogenity p < 0.0001, I² = 95.54%), Hb drop (SMD –1.452, 95% CI –3.590 to 0.687, p = 0.183, test for heterogenity p < 0.0001, I² = 99.08%), suturing difficulty (SMD –0.638, 95% CI –0.935 to –0.342, p ≤ 0.001, test for heterogenity p = 0.25, I² = 27.84%), suturing time (SMD –1.197, 95% CI –1.848 to –0.549, p ≤0.001, test for heterogenity p = 0.0001, I² = 83.30%) and total operative time (SMD –0.687, 95% CI –0.804 to –0.569, p ≤ 0.001, test for heterogenity p = 0.292, I² = 17.44%). Barbed suture demonstrated to be better in comparison with the control group even with regard to the length of hospitalization (SMD –0.278, 95% CI –0.543 to 0.012, p = 0.040, test for heterogenity p = 0.025, I² = 61.85%), and to perioperative complications (SMD 0.708, 95% CI 0.503–0.996, p = 0.048, test for heterogenity p = 0.79, I² = 0%). Conclusion: Barbed suture significantly facilitates laparoscopic myomectomy by reducing the total operative/suturing time, estimated blood loss/Hb drop, and reduction of perioperative complications.

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“…TAPP repair invariably requires peritoneal closure because the bowel may adhere to the exposed prosthetic mesh. However, use of the barbed suture is also associated with the risk of small bowel entrapment when the free end of the thread is cut long; potentially severe postoperative complications, such as intestinal obstruction, have been reported in such circumstances (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). To prevent these complications, the barbed suture may be additionally trimmed and buried using either absorbable sutures, or surgical clips (19).…”

Section: Discussionmentioning

confidence: 99%