New suture materials for midline laparotomy closure: an experimental study

Abstract

BackgroundMidline laparotomy closure carries a significant risk of incisional hernia. This study examines the behavior of two new suture materials, an elastic material, polyurethane (PUe), and a barbed polydioxanone (PDXb) suture thread in a rabbit model of midline incision closure.MethodsThree 2-cm midline incisions were made in 68 New Zealand White rabbits. The incisions were closed by running suture using four 3/0 threads: polypropylene (PP) (Surgipro®, Covidien), PUe (Assuplus®, Assut Europe), PDX (Assufil®, Assut Europe) or PDXb (Filbloc®, Assut Europe). Animals in each suture group were euthanized 3 weeks and 6 months after surgery. Histological sections of the tissue-embedded sutures were subjected to morphological, collagen expression, macrophage response and uniaxial tensiometry studies.ResultsNo signs of wound dehiscence or complications were observed. At 3 weeks, all sutures were surrounded by connective tissue composed mainly of collagen III. PUe showed greater collagen I expression than the other sutures. All sutures elicited a macrophage response that diminished from 3 weeks to 6 months (p < 0.001). This response was similar for the non-reabsorbable sutures (PP and PUe) yet PDXb showed a significantly greater response than the other reabsorbable suture (PDX) at 3 weeks (p < 0.01). At this early time point, the tensile strength of PUe was similar to that of control intact tissue (p > 0.05).ConclusionThree weeks after surgery, PUe revealed more collagen I deposition than the remaining materials and this translated to a similar biomechanical behavior to linea alba, that could avoid the appearance of short term dehiscences and thus reduce the incidence of incisional hernia. PDXb provides no additional advantages in their behavior regarding PDX suture.

RETRACTED ARTICLE: Use of Barbed Sutures in Bariatric Surgery. Review of the Literature

“…In 2014, Bellon et al [18] conducted a comparative study in rabbits by performing a 2-cm midline laparotomy for subsequent closure. The specimens were terminated after 3 weeks and samples with barbed and non-barbed sutures were studied, finding no differences in the morphological study, collagen expression, macrophage response, or biomechanical study.…”

Incisional infections associated with ventral midline celiotomy in horses

“…14 The healing tissue and the sutures are under tension produced by abdominal pressure and contraction of the flank muscles that insert within the linea alba. [13][14][15][16][17] The tension along the incision can result in hernia formation or dehiscence if the suture line fails or weakens prior to body wall healing. Tension along the incision also produces cyclic strain that stimulates fibroblast proliferation and alignment of the fibroblasts perpendicular to the direction of the strain during remodeling, accelerating wound proliferation and remodeling.…”

“…These events occur in a precisely synchronized pattern to reestablish the continuity and strength of the linea alba 14 . The healing tissue and the sutures are under tension produced by abdominal pressure and contraction of the flank muscles that insert within the linea alba 13–17 . The tension along the incision can result in hernia formation or dehiscence if the suture line fails or weakens prior to body wall healing.…”

Uso de las suturas barbadas en cirugía general y digestiva. Revisión de conjunto

“…En 2014, Bellon et al 17 publicaron un estudio comparativo en conejos a los que intervinieron mediante una laparotomía media de 2 cm para realizar su cierre posterior. A las 3 semanas se sacrificaron los especímenes y se estudiaron muestras con suturas barbadas y no barbadas, sin encontrar diferencias en el estudio morfoló gico, la expresió n colá gena, la respuesta macró faga ni el estudio biomecá nico.…”