title: Barbed versus usual suture for closure of the gastrojejunal anastomosis in laparoscopic gastric bypass: a comparative trial.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass is one of the main bariatric procedures that require safe and reproducible anastomosis. The objective of this study is to compare the risk of leaks and stenosis of a mechanical gastric pouch jejunal anastomosis between the usual interrupted sutures and a continuous barbed suture for gastrojejunotomy, in order to reduce procedure time and costs.
  
  
  METHODS
  A comparative trial of 100 consecutive patients undergoing laparoscopic Roux-en-Y gastric bypass was performed between October 2010 and July 2011. The population was divided into two groups of 50 consecutive patients. In the first group, gastrojejunotomy was sutured with resorbable interrupted sutures and the second with continuous barbed suture. Diabetes, body mass index and the American Society of Anaesthesiology score were compared. The time required for suturing and the incidence of anastomotic leaks and stricture were also compared after 6 months.
  
  
  RESULTS
  No fistulas or anastomotic stenoses had occurred at post-operative month 6 in either group. Gastrojejunotomy suture time was significantly shorter in the barbed suture group (11 versus 8.22 min; p < 0.01). Total costs of material to complete the reconstruction were significantly lower in the barbed suture group (€26.69 versus €18.33; p < 0.001).
  
  
  CONCLUSIONS
  The use of barbed suture is as safe as usual sutures and allows easier and faster suture in the closure of gastrojejunotomy. This suture could be incorporated in the standard laparoscopic Roux-en-Y gastric bypass technique.
authors.affiliation: Multidisciplinary Unit of Digestive and Endocrine Diseases, University Hospital Centre of Luxembourg, Luxembourg, Luxembourg. dr.vdeblasi@yahoo.it
authors.forename: Vito
authors.initials: V
authors.lastname: De Blasi
authors.forename: Olivier
authors.initials: O
authors.lastname: Facy
authors.forename: Martine
authors.initials: M
authors.lastname: Goergen
authors.forename: Virginie
authors.initials: V
authors.lastname: Poulain
authors.forename: Luigi
authors.initials: L
authors.lastname: De Magistris
authors.forename: Juan Santiago
authors.initials: JS
authors.lastname: Azagra
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects* / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D006801:Humans; D007583:Jejunum / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome