title: Enterotomy closure using knotless and barbed suture in laparoscopic upper gastrointestinal surgeries.
abstract: BACKGROUND
  Barbed sutures are recently being employed in intracorporeal suturing in various laparoscopic digestive surgeries. The purpose of this paper was to present our initial experience of enterotomy closure with barbed sutures in upper gastrointestinal and bariatric surgeries, and share optimal technique of using such sutures for enterotomy closure.
  
  
  METHODS
  Fifty patients who underwent laparoscopic closure of enterotomies using barbed sutures were identified in two institutions in Singapore from January 2012 to December 2013. Patient demographics, short-term operative outcomes including anastomotic time, onset of diet, hospital stay, and early post-operative complications are reported.
  
  
  RESULTS
  In 50 patients a total of 62 anastomotic sites were closed with barbed sutures. The barbed sutures appear to reduce mean anastomotic suturing time of the Roux-en-Y gastrojejunal closure (17.34 vs 44.55 min, p value 0.0001) and jejunojejunal closure (19.46 vs 31.01 min, p value 0.0013) when compared to a subgroup of patients with the same anastomotic sites closed using the standard non-barbed suture. The mean onset to start on diet was 2 ± 1.5 days and mean duration of hospital stay is 7 + 5.3 days. One (1.6%) anastomotic leak was observed day 3 after a gastric bypass in the series. This leak was the result of a technical error due to inappropriate suturing technique. There were no mortalities, other complications or readmission. While applying traction on the suture brings two tissue edges closer, we observed that pushing the tissues toward each other provided more apposition and prevented unnecessary tearing of tissues that could potentially result in complications
  
  
  CONCLUSIONS
  Barbed closure sutures appear to be safe and effective in laparoscopic upper gastrointestinal procedures for closing enterotomies provided appropriate technique is used. The potential benefit is simplifying intracorporeal enterotomy closure.
authors.affiliation: Upper Gastrointestinal Surgery Division, Department of Surgery, National University Hospital, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Therese
authors.initials: T
authors.lastname: Bautista
authors.affiliation: Upper Gastrointestinal Surgery Division, Department of Surgery, National University Hospital, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore. cfsasim@nus.edu.sg.|National University of Singapore, Singapore, Singapore. cfsasim@nus.edu.sg.
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
authors.affiliation: Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Jaideepraj
authors.initials: J
authors.lastname: Rao
authors.affiliation: Upper Gastrointestinal Surgery Division, Department of Surgery, National University Hospital, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore.|National University of Singapore, Singapore, Singapore.
authors.forename: Jimmy
authors.initials: J
authors.lastname: So
authors.affiliation: National University of Singapore, Singapore, Singapore.
authors.forename: Koji
authors.initials: K
authors.lastname: Kono
authors.affiliation: Upper Gastrointestinal Surgery Division, Department of Surgery, National University Hospital, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Durai
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004766:Enterostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*
keywords: Barbed suture; Bariatric surgery; Enterotomy anastomosis; Gastrojejunostomy; Intracorporeal suturing; Roux-en-Y gastric bypass