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Barbed sutures are as safe as conventional sutures for closing RYGB anastomotic defects

Italian researchers have reported that barbed sutures are effective at reducing operating times and are as safe as conventional sutures for closing anastomotic defects during Roux-en-Y Gastric Bypass (RYGB). Their findings promote the routine use of barbed sutures to close the enterotomies of both anastomoses during RYGB as a safe and effective technique for dealing with early and late postoperative complications.

Stratafix (Ethicon)

Italian researchers have reported that barbed sutures are effective at reducing operating times and are as safe as conventional sutures for closing anastomotic defects during Roux-en-Y Gastric Bypass (RYGB). Their findings promote the routine use of barbed sutures to close the enterotomies of both anastomoses during RYGB as a safe and effective technique for dealing with early and late postoperative complications.

The authors stated that the implementation of barbed sutures appears to enhance the process of suturing and knot tying, particularly in the field of bariatric surgery, where they can offer significant advantages. The objective of their research was to evaluate the safety and effectiveness of utilising barbed sutures for gastric pouch-jejunal anastomosis (GPJA) and jejuno-jejunal anastomosis (JJA) anastomosis in Roux-en-Y Gastric Bypass (RYGB).


They performed a retrospective analysis on prospectively collected data from a bariatric database, encompassing patients who underwent primary bariatric surgery at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS between January 2012 and October 2018. The primary end-point was the comparison of barbed vs. conventional sutures in terms of early complication rate (30-day). The secondary endpoint was comparing the two groups in terms of late complications (internal hernias and small bowel obstructions), operative time and postoperative hospital stay.

To note, the monofilament absorbable 3/0 PDS (Ethicon) for both the anastomoses was routinely used until December 2014, and the 2/0 monofilament unidirectional barbed absorbable suture (Stratafix, spiral monocryl plus, Ethicon) for both the anastomoses was used from October 2017 in all patients.


In total 421 patients were included in the study, 260 in the conventional suture group (CS-G) and 161 in the barbed suture group (BS-G). After Propensity Score Matching (PSM), the study population comprised 322 patients: 161 in CS-G and 161 in BS-G. The two groups were comparable for age, gender, weight, BMI and comorbidities, such as obstructive sleep apnoea syndrome and high blood pressure. No intraoperative deaths and no intraoperative leaks (detected at the methylene blue test) were registered.

Postoperative complications were comparable for both groups: 4 (2.5%) for CS-G and 6 (3.7%) for BS-G (p = 0.521). There was one case (0.6%) of GPJA’s leakage in CS-G (p=0.5) and one case (0.6%) of JJA’s stenosis in BS-G (p=0.5). Other postoperative complications included: one (0.6%) case of self-limiting extraluminal bleeding (Clavien–Dindo II) in CS-G (p = 0.317) and two (1.2%) cases of self-limiting intraluminal bleeding (Clavien–Dindo II) in BS-G (p = 0.159), two (1.2%) cases of surgical site infections (Clavien–Dindo I and Clavien–Dindo II) in CS-G and three (1.8%) cases of surgical site infections (two Clavien–Dindo I and one Clavien–Dindo II) in BS-G (p=0.317).


The median operative time was significantly shorter for BS-G: 65 (58–80) vs. 95 (80–125) minutes (p< 0.001). The median postoperative hospital stay was significantly lower for BS-G: 2 (2–3) vs. 5 (5–6) days (p<0.001). Follow-up was completed in all patients (160 out of 160 patients for CS-G vs. 161 out of 161 patients for BS-G, respectively). The median follow-up time was shorter in BS-G: 60 (58–63) vs. 113 (117–119) months.


During this period, we registered one (0.6%) case of small bowel obstruction in CS-G and one (0.6%) case in the other group (p=0.996). There was also a comparable rate (p=0.768) of internal hernias requiring surgical revision: seven (4.3%) cases in CS-G and six (3.7%) cases in BS-G. The median time of onset of the clinical presentation of internal hernias in the entire series was 22 (19–32) months.


Although the researchers did not perform a completed cost analysis, they noted the utilisation of the barbed suturing technique did not result in a major change in the cost associated with the procedures. Indeed, their results are similar to those reported in the study of Lin et al. (Lin, Y.; Long, Y.; Lai, S.; Zhang, Y.; Guo, Q.; Huang, J.; Du, L. The Effectiveness and Safety of Barbed Sutures in the Bariatric Surgery: A Systematic Review and Meta-analysis. Obes. Surg. 2019, 29, 1756–1764), indicating that barbed sutures may be cheaper than conventional ones, but the authors concluded that these results need to be interpreted cautiously (De Blasi, V.; Facy, O.; Goergen, M.; Poulain, V.; De Magistris, L.; Azagra, J.S. Barbed Versus Usual Suture for Closure of the Gastrojejunal Anastomosis in Laparoscopic Gastric Bypass: A Comparative Trial. Obes Surg. 2013, 23, 60–63).

“In our experience, similarly to others reported in the literature, we obtained some clear advantages with barbed sutures, including an important reduction of operative time,” they concluded. “Although further prospective randomised studies with appropriate sample sizes are needed to confirm our results and to perform a proper cost analysis, we encourage using barbed sutures over conventional ones during anastomotic reconstructions in bariatric operations.”

The findings were reported in the paper, ‘Barbed vs. Conventional Sutures in Bariatric Surgery: Early and Late Outcomes’, published in MDPI Open Access Journals. To access this paper, please click here




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