title: Barbed Versus Conventional Suture: A Randomized Trial for Suturing the Endometrioma Bed After Laparoscopic Excision of Ovarian Endometrioma.
abstract: To determine whether the unidirectional knotless barbed suture can be used to control bleeding from the endometrioma bed after laparoscopic excision of ovarian endometrioma, and to detect whether the use of the unidirectional barbed suture is associated with shorter suturing time of the endometrioma bed compared with the continuous conventional smooth suture with intracorporeal knot tying.
  
  
  
  Randomized clinical trial (Canadian Task Force classification I).
  
  
  
  Tertiary hospital.
  
  
  
  Forty patients with unilateral ovarian endometrioma (mean diameter, 3-10 cm) were randomized in a 1:1 ratio to the barbed suture group or the conventional suture group.
  
  
  
  The endometrioma bed was sutured either with unidirectional barbed suture (V-Loc 180; Covidien, Mansfield, MA) or conventional suture (Vicryl; Ethicon, Somerville, NJ). Two layers of continuous sutures were used to control bleeding from the endometrioma bed and to reapproximate the ovarian edges.
  
  
  
  The degree of suturing difficulty was evaluated by the surgeons using a visual analog scale (VAS) ranging from 1 (least difficult suturing) to 10 (most difficult suturing). Operating time and suturing time were significantly shorter in the barbed suture group (43.3 ± 10.54 vs 52.8 ± 9.69 minutes; p = .005 and 8.85 ± 2.52 vs 15.7 ± 4.12 minutes; p < .001, respectively). Suturing with barbed suture was less difficult than suturing with conventional suture (3.68 ± 1.37 vs 4.77 ± 1.56; p = .025). Intraoperative blood loss was similar in the 2 groups. No perioperative complications were reported in either group. A nonsignificant decrease in serum anti-mullerian hormone (AMH) levels was observed after the operation in the barbed suture group and the conventional suture group (3.04 ± 1.5 vs 2.52 ± 1.31 ng/mL; p = .252 and 2.76 ± 1.48 vs 2.13 ± 1.14 ng/mL; p = .139, respectively). The rate of decline in serum AMH levels after the operation was 18.32% in the barbed suture group and 22.84% in the conventional suture group.
  
  
  
  The unidirectional knotless barbed suture (V-Loc) facilitates suturing of the endometrioma bed after laparoscopic excision of ovarian endometrioma. Compared with conventional smooth suture (Vicryl), the unidirectional barbed suture reduces the time needed to suture the endometrioma bed and the total operating time.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: umfrfouda@yahoo.com.
authors.forename: Usama M
authors.initials: UM
authors.lastname: Fouda
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Elsetohy
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Hesham S
authors.initials: HS
authors.lastname: Elshaer
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D004715:Endometriosis / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures
chemical_list: D054304:Anti-Mullerian Hormone
keywords: Barbed suture; Conventional suture; Endometrioma; Endometriosis; Laparoscopy; Ovarian reserve; Suturing time