title: Laparoscopic gastrointestinal anastomoses using knotless barbed absorbable sutures are safe and reproducible: a single-center experience with 242 patients.
abstract: OBJECTIVE
  Intracorporeal reconstruction of the digestive tract is technically challenging. The V-Loc 180 wound closure device (Covidien) is a self-anchoring unidirectional barbed suture that obviates the need for knot tying. The aim of this prospective cohort study was to investigate the use of the novel suture in gastrointestinal enterotomy closure.
  
  
  METHODS
  The subjects comprised patients with malignant disease who were scheduled to undergo laparoscopic gastrectomy with curative intent. The barbed suture was used to close the entry hole for the linear stapler during intracorporeal reconstruction following laparoscopic gastric resection. The primary endpoint was the proportion of patients who developed anastomotic leakage at the site where the barbed suture was applied.
  
  
  RESULTS
  Between July 2012 and March 2015, 242 patients were enrolled. Of 362 anastomoses, the enterotomy hole at 256 sites was closed using the barbed suture. These 256 sites consisted of 95 gastroduodenostomies, 25 gastrogastrostomies, 13 gastrojejunostomies, 90 jejunojejunostomies, 17 esophagojejunostomies and 16 primary closures of the stomach following local gastric resection. There were no anastomosis-related complications, conversion to usual sutures, mechanical closure of the entry hole and reoperation due to adhesive obstructions or mortality over a median follow-up period of 17.8 months.
  
  
  CONCLUSIONS
  The use of the unidirectional barbed absorbable suture for gastrointestinal closure is safe and effective in laparoscopic gastrectomy.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka sur079@poh.osaka-med.ac.jp.
authors.forename: Sang-Woong
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kawai
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Tashiro
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nomura
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka.
authors.forename: Takaya
authors.initials: T
authors.lastname: Tokuhara
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawashima
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka.
authors.forename: Ryo
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D013270:Stomach / Q000601:surgery*; D013537:Sutures
keywords: barbed suture; gastric cancer; intracorporeal anastomosis; laparoscopic gastrectomy
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