title: Laparoscopic percutaneous jejunostomy with intracorporeal V-Loc jejunopexy in esophageal cancer.
abstract: Barbed sutures are widely used in various laparoscopic digestive surgeries. The purpose of this paper is to present our initial experience of laparoscopic percutaneous jejunostomy with unidirectional barbed sutures in esophageal cancer patients and compare it with our early cases using traditional transabdominal sutures.
  
  
  
  A total of 118 esophageal cancer patients who underwent laparoscopic percutaneous jejunostomy were identified in a single institution in Taiwan from June 2014 to May 2016. The authors' traditional technique consisted of using transabdominal sutures with bolsters to fix a jejunum loop onto the anterior abdominal wall. A novel technique was introduced using intracorporeal suturing with knotless unidirectional barbed monofilament absorbable sutures (V-Loc) to attain a seal around the feeding catheter. A comparison between these two techniques was performed.
  
  
  
  Twenty cases with barbed V-Loc sutures and 98 cases with transabdominal sutures were identified. The V-Loc sutures appeared to reduce peristomal skin ulcers (19.4 vs. 0 %, p = 0.040), postoperative pain scores during the first 24 h (1.8 ± 1.4 vs. 0.9 ± 1.1, p = 0.007) and on postoperative day 2 (1.7 ± 1.4 vs. 1.0 ± 0.8, p = 0.026) when compared to patients receiving transabdominal sutures. The mean suturing time using V-Loc sutures was 22 min (14-60 min). The mean onset to resumption of enteral feeding was 1.8 ± 0.8 days and the mean duration of postoperative hospital stay was 8 ± 5.1 days, both of which were comparable in the two groups. There was no surgical mortality in our series.
  
  
  
  In the study cohort, the use of knotless unidirectional barbed sutures instead of traditional transabdominal sutures had similar outcomes and appears to be a feasible option for intracorporeal jejunopexy when performing laparoscopic jejunostomy in patients with esophageal cancer.
authors.affiliation: Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taipei, Taiwan.|Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.
authors.forename: Shun-Mao
authors.initials: SM
authors.lastname: Yang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.
authors.forename: Wei-Ling
authors.initials: WL
authors.lastname: Hsiao
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC.
authors.forename: Jui-Hsiang
authors.initials: JH
authors.lastname: Lin
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC.
authors.forename: Pei-Ming
authors.initials: PM
authors.lastname: Huang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan, ROC. jangming@ntuh.gov.tw.
authors.forename: Jang-Ming
authors.initials: JM
authors.lastname: Lee
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013536:Suture Techniques; D013537:Sutures; D013624:Taiwan
keywords: Barbed suture; Esophageal cancer; Laparoscopic jejunostomy; V-Loc