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Comparison of barbed and conventional sutures in adhesion formation and histological features in a rat myomectomy model: Randomized single blind controlled trial

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  • International School of Medicine, University of Health Sciences
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... Such adverse events might occur due to a potentially increased risk of adhesion formation or inflammation, resulting from the entrapment of barbs in the neighboring tissue. [6][7][8][9] Adhesions can hamper the functions of abdominal organs, leading to infertility, chronic pelvic pain or increased morbidity. 10 The aim of this study was to determine whether differences in surface textures, resulting from the variations in the geometric configurations of the barbs lead to differences in intra-abdominal adhesion formation. ...
... The animal model to test for intraperitoneal adhesions has previously been used by Api et al. 9 In the control group, the abdominal cavities were entered as previously described and closed without performing any further surgical procedures. In the study groups, a 2-centimeter incision was made with a No. 15 scalpel on the anti-mesosalpingeal side of one of the uterine horns to mimic a myomectomy wound. ...
... In a study by Api et al., V-loc barbed sutures were found to provoke less inflammatory tissue response, but a statistically significantly higher amount of clinical adhesion formation than polyglactin 910 (Vicryl) sutures. 9 Similar results were observed when V-loc and Vicryl sutures were compared for cystotomy repair in rats. 17 Different results in the adhesion scores reported by Einarsson et al. and Api et al. when barbed sutures (Quill and V-loc) were compared with standard sutures (Vicryl) may not only be a result of the different methodologies used in the studies (for example, the type of animals used -rat vs ewe, the type of instrument used for the incision over the horns -scalpel vs harmonic scalpel, or the follow-up period after the surgeries -6 weeks vs 3 months), but also of the different surface textures of the sutures. ...
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Background: The obstetrics and gynecology literature has expanded in recent years to include clinical trials assessing the use of barbed sutures. The difficulty of intracorporeal suturing continues to be a barrier to a wider use of laparoscopy. Although the use of barbed sutures has been shown to ease the process of laparoscopic suturing considerably, concerns have been raised regarding a potentially increased risk of adhesions or inflammation as a result of their use. Objectives: The aim of this study was to determine whether differences in surface textures, resulting from the variations in the geometric configurations of barbs, lead to differences in intra-abdominal adhesion formation. Material and methods: A total of 27 non-pregnant female Wistar Hannover rats, weighing 200-250 g, with intact uteri were used as an adhesion formation model. The rats were randomly assigned to 3 groups: barbed suture group 1, barbed suture group 2 and control group (no intracorporeal suture). A 2-centimeter vertical incision was performed on the anti-mesosalpingeal side of one of the uterine horns. The incision on the uterine horn was reapproximated with a running suture, entailing 3 needle punctures and left untied at one end. Six weeks after the operation, intra-abdominal adhesion formations were investigated both clinically and histopathologically. Results: Clinical adhesion scores and histopathological parameters in both the barbed suture groups were statistically significantly higher than in the control group (p < 0.05). There was no significant difference between the barbed suture groups regarding the adhesion scores. Conclusions: The 2 types of barbed sutures with different surface textures, used for myometrial closure, form a similar profile with respect to postoperative adhesion formation.
... Despite the several potential advantages of barbed sutures, some case reports have indicated that this suture material might be associated with small bowel obstruction or volvulus after intra-abdominal placement [4][5][6]. In an animal study, Einarsson et al. [7] reported no differences in adhesion formation and adhesion severity between bidirectional barbed suture and standard suture; however, our recent rat study revealed that unidirectional barbed suture might be associated with more adhesions than standard suture [8]. ...
... Some suture materials have been found to cause more adhesions than others [8,17,18], and the reported evidence regarding differences in adhesion formation between peritoneal closure and nonclosure is inconsistent [19,20]. Prevention of intra-abdominally placed foreign bodyrelated adhesion has been rarely studied. ...
... We had assumed that the barbed suture might have an adverse effect on the adhesion formation when used in intra-abdominal surgery. To evaluate this hypothesis, we conducted a randomized controlled trial in a rat myomectomy model [8] comparing unidirectional barbed polyglyconate suture material with standard polygylactine 910 suture materials. ...
Article
Study objective: To compare adhesion formation and histological features of peritoneal closure and nonclosure over an intra-abdominally placed barbed suture. Design: Single-blind randomized controlled trial (Canadian Task Force Classification I). Setting: Certified animal research facility. Subjects: Eight nonpregnant rats. Interventions: Abdominal cavities were entered via midline incision. Left and right parietal peritoneal surfaces were incised 1.5 cm long separately and stitched with unidirectional barbed suture material (3/0 V-Loc). The parietal peritoneum was approximated over the barbed suture using polypropylene suture material (7/0 Prolene) to embed the barbed suture (peritonization) on one side, and left open on the other side. The side of the barbed suture to be peritonized was allocated at random. On the postoperative day 32, all rats were sacrificed, adhesion formations on each side were macroscopically scored, and histological features were evaluated microscopically. Measurement and main results: The median adhesion score was 2.00 (range, 1-4) on operative fields. There was no statistically significant difference in median adhesion score between the peritonized and nonperitonized sides (1.5 vs 2, respectively; p = .13). Microscopically, there were no statistically significant differences in median acute and chronic inflammation scores between the peritonized and nonperitonized sides (p = .58 and p = .45, respectively), but a significantly higher median fibrosis score on the peritonized side (3 vs 1.5, respectively; p = .02). Conclusion: Based on the results of the present study in a rat model, barbed suture material might be associated with adhesion formation when used intra-abdominally, and these adhesions could not be prevented by peritonization.
... However, animal studies have shown mixed results. One study in ewes found no difference in adhesion formation between barbed and polyglactin sutures [21], while a similar study in rats observed increased adhesion formation and a greater presence of inflammatory cells with barbed sutures [22]. ...
Article
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Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.
... Though a study [35] assured the safety of the use of barbed sutures, two case-reports of small bowel volvulus and obstruction resulting from barbed sutures were published [51,52]. Animal studies showed conflicting results, with one study in ewes showing no difference in adhesion formation between barbed and polyglactin sutures [53], while a similar experiment in rats found more adhesion formation and increased presence of inflammatory cells with barbed sutures [54]. ...
Article
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Vaginal cuff dehiscence (VCD) is a rare but serious condition associated with high morbidity, especially in the presence of an evisceration. It usually occurs as a complication of hysterectomy, but has also been reported after other pelvic surgeries. In this article, we will present two cases of vaginal cuff dehiscence with evisceration in post-menopausal patients. Both cases occurred post-operatively, the first after a laparoscopic radical hysterectomy and the other after a trachelectomy performed by robotic-assisted laparoscopy (with a prior history of subtotal hysterectomy). Both cases were treated surgically, the first by a combined laparoscopic and vaginal approach, and the second case only by laparoscopic approach. The main risk and protective factors are discussed in a narrative literature review which summarizes the available evidence on this rare condition, discussed by type of study designs and thus evidence level. A laparoscopic vaginal cuff closure is the most protective factor in preventing VCD, compared to a vaginal closure. Clinicians should be aware of this condition and of its risk factors and precipitating events in order to identify high-risk patients. Knowledge of these allows prompt recognition, which is crucial for adequate management, for which multiple approaches have been described.
... Several studies have reported bowel obstruction and perforation due to adhesion formation secondary to BS [4,5]. Besides, a randomized controlled trial (RCT) with an animal model has revealed that BS is significantly more associated with adhesion formation than is CS [6]. Contrarily though, another RCT/animal model found no difference in adhesion formation between BS and CS [7]. ...
Article
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Background: There is still concern regarding postoperative adhesion formation and adverse effects on pregnancy outcomes caused by barbed suture (BS) after myomectomy. The aim of this study was to compare the postoperative adhesion and pregnancy outcomes between conventional suture (CS) and BS after minimally invasive myomectomy (MIM) by robotic myomectomy (RM) or laparoscopic myomectomy (LM). Methods: The medical records of 94 women who had undergone MIM with CS and 97 who had undergone MIM with BS and achieved pregnancy were reviewed. Postoperative adhesion was evaluated following cesarean section. Results: The number of removed myomas was greater (5.3 ± 4.6 vs. 3.5 ± 3.1, p = 0.001) and the size of the largest myoma was larger (7.0 ± 2.2 vs. 5.8 ± 2.7 cm, p = 0.001) in the BS group relative to the CS group. A total of 98.9% of patients in the CS group and 45.4% in the BS group had undergone LM (p < 0.001), while the others underwent RM. There was no significant difference in the presence of postoperative adhesion at cesarean section between the BS and CS groups (45.5 vs. 43.7%, p = 0.095). Additionally, there were no intergroup differences in pregnancy complications such as preterm labor, placenta previa, accrete or abruption. Note also that in our logistic regression analysis, the suture type (BS or CS) was excluded from the independent risk factors regarding postoperative adhesion formation. Conclusions: Our data indicated that the incidence of postoperative adhesion after MIM with BS was similar when compared with CS. Also it seems that the suture type does not have a significant effect on pregnancy outcomes.
... Incidentally, if barbed suture is anchored to the mesentery or bowel wall; the length of secured tail end further increases due to subsequent pulls by intestinal peristalsis. The same mechanism was explained in studies by Sakata et al. 6 and Api et al. 7 A similar case report as ours was reported in various other studies. 3,[8][9][10] Bowel obstruction has been reported as early as postoperative day 3 to as late as 122 days. ...
Article
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Introduction: A case report of small bowel obstruction related to barbed suture in a postoperative patient of laparoscopic sacrocolpopexy. Case description: A 61 -year-old female with a body mass index of 27 with vault prolapse underwent laparoscopic sacrocolpopexy. The patient was discharged on postoperative day two. She presented again in the emergency department on the fifth postoperative day with complaints of frequent vomiting episodes with intermittent and colicky pain in the abdomen. Her imaging (computed tomography abdomen/pelvis with oral contrast) suggested distal small bowel mechanical obstruction at midileum with significant free fluid in the peritoneum. Emergency laparoscopic exploration was done. Peroperative V-LocTM 180 suture tail end barbs were found anchored to the mesentery of midileum causing a loop that led to compression and occlusion of distal bowel. The barbed suture tail end was detached from the mesentery and thus relieving the compression. No additional procedure was required for the bowel wall. The excess barbed suture tail end outside the peritoneum was trimmed. The postoperative course was uneventful. Conclusion: Bowel complication is an uncommon but serious issue following the use of barbed sutures. It should be used with utmost caution as none of the preventive measures are completely safe. Further studies need to be done for preventive measures.
... 22 The scar assessment scale showed that regardless of whether the Although some studies showed that the barbed suture has a better anchoring effect and improved the appearance of in cutaneous scars, 25,26 it also caused more severe inflammatory reactions and increased episodes of delayed wound healing. 27 These two suture methods have their own advantages and disadvantages, and how to weigh the benefit of these two choices still requires further research. ...
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Background: The inframammary approach is one of the most commonly used incisions in breast augmentation. There are many suture methods for inframammary incisions; however, no one method has proven optimal. We modified the traditional three-layer suture method according to the inframammary fold (IMF) cadaver dissection results. This study aims to investigate whether using a modified suture method can improve postoperative outcomes. Methods: Cadaver dissections were performed in order to clarify the anatomy of the IMF. From June 2013 to December 2017, a retrospective study of primary breast augmentation patients subjected to the inframammary approach was conducted. Patients were divided into two cohorts: the traditional suture method and the modified suture method. The patient's demographics, specifics of breast augmentation procedures, complications, and scar assessment were analyzed. Univariate and multivariable analyses were used to determine differences between the two cohorts. Results: One hundred eighty-four patients were included: 75 patients were subjected to the traditional suture method, and 109 patients were subjected to the modified suture method. Wound-related adverse events (p=0.026) and IMF-indented scarring (p=0.014) were significantly different between the two groups. Multivariable analysis showed that the suture method was the most influential factor related to IMF-indented scarring (OR=16.9), followed by BMI (OR=2.9). Conclusions: We defined a new suture method for the inframammary incision in primary breast augmentation. This modified suture method reduces the occurrence of wound-related adverse events and IMF-indented scarring.
... A study investigated two different suture materials in a rat myomectomy model. The median macroscopic adhesion score was significantly higher when a barbed suture material (polyglyconate) was used compared to the standard suture material (polyglactin-910) [32]. ...
... A meta-analysis revealed that laparoscopic myomectomy is associated with less decline in hemoglobin concentration, operative blood loss, pain and complications as compared with open myomectomy. On the other hand, the operative time is significantly shorter with open myomectomy (4). During laparoscopic myomectomy, suturing of uterine defect after enucleation of the myoma is the most challenging and time consuming step of the procedure. ...
Article
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To assess the differences in surgical outcomes between bidirectional barbed suture and conventional suture for myoma bed closure during laparoscopic myomectomy. Study design: Ninety-two patients with one to three symptomatic myomas were randomized in a 1:1 ratio to the barbed suture group or the conventional suture group. Myoma bed was sutured either with barbed suture (STRATAFIX™, Ethicon Inc, USA) or continuous conventional suture with intracorporeal knot tying (Vicryl; Ethicon, USA). The surgeon assessed the degree of suturing difficulty using a visual analog scale ranging from 1 (least difficult suturing) to 10 (most difficult suturing). Results: Suturing with barbed suture was easier than suturing with conventional suture (3.04±1.47 Vs. 4.75± 1.35, P < 0.001). Suturing time of the myoma bed was significantly shorter in the barbed suture group (14.98±4.81 Vs 22.09±6.9 min; P < 0.001). Operative time was comparable between both groups (69.67±17.63 Vs 74.15±19.79 min; P = 0.255). The mean intraoperative blood loss was significantly higher in conventional suture group (337.24±234.15 ml Vs 211.3±107.62; P= 0.002). Conclusion: The barbed suture facilitates suturing of the myoma bed during laparoscopic myomectomy. Compared with conventional suture, barbed suture reduces the time needed to suture the myoma bed and the intraoperative blood loss.
... (5)(6)(7)(8) There is conflicting evidence regarding post-operative adhesion formation with the use of barbed sutures in the available animal model studies. (9,10) Pelvic adhesions are postulated to affect fertility in women. (11) Also, there are insufficient studies exploring the impact of barbed sutures on uterine tissue and its obstetric outcomes, such as uterine rupture or placental complications. ...
Article
Study objective: To study the reproductive outcomes after laparoscopic myomectomy comparing conventional (non-barbed) suture with barbed suture, used for myometrial defect closure. Design: Monocentric retrospective cohort study with prospective follow up survey for reproductive outcomes conducted in April-May 2020. Setting: Tertiary care center (Center for advanced gynecological laparoscopy and infertility) PATIENTS: Women who underwent laparoscopic myomectomy for uterine leiomyomas from January 2004 - December 2017. Intervention: Laparoscopic myomectomy with the closure of myometrium using either conventional (non-barbed sutures) or barbed sutures and follow-up survey regarding reproductive outcome. Measurements: Rate of conception, pregnancy complications, mode of delivery, perioperative complications for both kinds of suture materials used. Results: Of 399 women who underwent laparoscopic myomectomy, 343 patients satisfied the inclusion criteria were followed up, and 235 patients responded. 120 patients were in the non-barbed group (group A) and 115 patients in the barbed group (group B). 182 (Group A 97 vs. Group B 85; p-value .204) women had actively sought pregnancy post-operatively, of which 93 patients (51.09%) in total and 51 (54.8%) in group A Vs. 42 (45.1%) in group B reported at least one pregnancy with no significant difference in incidence rate ratios between the two groups. Of the recorded pregnancies, 84.9 % (group A 88.2% vs. group B 80.9%) live births, 6.4 % (group A 5.8% Vs. group B 7.1%) had first trimester miscarriages, 2.1 % (group A 1.9% vs. group B 2.3%) had an ectopic pregnancy and 6 were ongoing pregnancies at the time of the study analysis which were analyzed and compared statistically in both the study groups. The pregnancy-related complications were noted in 12 out of 93 pregnant women (12.9%), which were comparable in both the groups, and no cases of uterine ruptures were reported. Conclusion: Our study supports the good reproductive outcome of women after laparoscopic myomectomy with barbed sutures. Further, the inclusion of non-barbed sutures as a control group in our study reinforces that barbed sutures in myomectomy are equally safe and an easier alternative to conventional sutures without affecting the pregnancy outcomes.
... Cutting barbed filament tails short enough may contribute to lessening this risk (33)(34)(35). Suture peritonization may not represent a valid solution since it does not avoid adhesion formation, as demonstrated by Api et al. in rats (36). The cases we reported in this study are the 21st and 22nd described in the literature by the time this article was written. ...
Article
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Introduction: A high level of surgical ability is required to perform endoscopic knot tying. Barbed sutures help in avoiding this procedure, thus reducing intraoperative time and lowering blood loss and hospitalization time when compared to traditional sutures. Some cases of bowel occlusion following the use of barbed sutures have been described in literature. All of them are characterized by the entanglement of an intestinal loop in wire barbs with bowel occlusion symptoms. Case Presentation: We report two more cases which occurred in our Institute in 2020 and review those which have been reported in the literature by searching on Pubmed, Scopus, and Embase. We used the search terms: “Barbed,” ”Suture,” “Bowel,” and ”Obstruction.” We examined in the literature the surgical procedures, the type of complications, the time to onset of the complications, and the type of barbed suture. Discussion: Twenty-two cases in total were reported in the literature from 2011 to 2020, and bowel complications were largely subsequent to interventions such as hernia surgical repair and myomectomy. In order to take advantage of barbed sutures while minimizing the risk of adverse events, such as intestinal occlusion, some precautions may be considered, such as the shortening of thread tails and use of antiadhesive barriers. Moreover, performing a few stitches backwards when ending the suture might be a useful suggestion. Further studies in this field may be useful in order to assess whether it might be better avoiding barbed suture application on serosal tissues to prevent bowel damage.
... The median macroscopic adhesion score was significantly higher when a barbed suture material (polyglyconate; V-Loc™) was used compared to the standard suture material (polyglactin-910; Vicryl ® ). [28] further InfluencIng fActors ...
Article
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Uterine fibroids or uterine myomas are one of the most common benign diseases of the uterus. Symptoms associated with myomas can make surgical removal of myomas necessary. Besides the traditional abdominal route, laparoscopic myomectomy (LM) has gained more acceptances over the last few decades, and it is anticipated that laparoscopy is associated with lower adhesion development. Therefore, we conducted this review to analyze the evidence on adhesions after LM. The PubMed database was searched using the search terms "myomectomy" alone and in combination with "adhesions," "infertility OR fertility outcome," and "laparoscopy" among articles published in English and German. Although the well-known advantages of laparoscopy, for example, less pain, less blood loss, or shorter hospital stay, myomectomy belongs to high-risk operations concerning adhesion formation, with at least every fifth patient developing postsurgical adhesions. In laparoscopic surgery, surgeons´ experience as well tissue trauma, due to desiccation and hypoxia, are the underlying mechanisms leading to adhesion formation. Incisions of the posterior uterus may be associated with a higher rate of adhesions compared to anterior or fundal incisions. Adhesions can be associated with severe complications such as small bowel obstruction, chronic pelvic pain, complications in further operations, or impaired fertility. Tissue trauma and the experience of the surgeon in laparoscopic surgery are most of the influencing factors for adhesion formation after myomectomy. Therefore, every surgeon should adopt strategies to reduce adhesion development in daily routine, especially when it conducted to preserve or restore fertility.
... 23 Recently, several groups have investigated the BPS behavior in animal models with different organs. 24,25 Zaruby et al 24 compared 2 commonly used BPS, the V-Loc and the Quill Monoderm, with a conventional monofilament thread (Biosyn) regarding biomechanical and histologic data, from cosmetically closed skin incisions, in a porcine model. The V-Loc demonstrated, at all time periods, the lowest tissue reaction scores in comparison with Biosyn threads. ...
Article
OBJECTIVE To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. MATERIALS AND METHODS Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. RESULTS The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). CONCLUSION The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments. UROLOGY 116: 231.e1–231.e5, 2018. © 2018 Elsevier Inc.
... With the exception of clinical reports mostly on side-to-side anastomosis [8] and various experimental studies on enterotomy [5,[9][10][11], little has been published so far. The most interesting application of barbed sutures is in plastic and laparoscopic surgery because of their handling characteristics but their use has been described in in-vivo open surgery techniques in humans [9,[13][14][15][16][17] and animals [12,[18][19][20][21][22][23][24]. Barbed sutures have proven effective in performing end-to-end anastomosis ex-vivo in humans [9], dogs [25], and horses [4]; however, no experimental study has evaluated the characteristics of jejuno-jejunal anastomoses in vivo to date. ...
Article
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Background Hand-sewn intestinal anastomoses are a fundamental procedure in both open and laparoscopic intestinal surgery. Self-retaining barbed suture devices have been tested for a variety of surgical applications. With the exception of clinical reports and various experimental studies on enterotomy, little has been published so far on the use of barbed suture for end-to-end intestinal anastomoses. The aim of the study was to compare two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. End-to-end jejuno-jejunal anastomosis were performed with unidirectional barbed (A group), bidirectional barbed (B group) or normal (C group) sutures in each animal. A comparison was then made between the groups based on adhesions scoring, suturing time, bursting pressure and histopathology. Results Mean construction times in the A group (518 ± 40 s) and in the B group (487 ± 45 s) were significantly lower than in the C group (587 ± 63 s) but were not different between A and B group (P = 0.10). Mean bursting pressures were significantly higher in the intact intestine (197 ± 13 mmHg) than in any other group (group A 150 ± 16 mmHg, group B 145 ± 22 mmHg, group C 145 ± 24 mmHg). Among anastomotic techniques, the bursting pressures were not significantly different. Histologically no difference could be detected in the grade of inflammation, collagen deposition and neovascularization at the anastomotic sites. Conclusions Barbed sutures can be effectively used for handsewn end-to-end jejunojejunal anastomosis in pigs. They are comparable to normal suture but could provide a shorter surgical time.
... It is not clear, whether the intra-abdominal placement of barbed sutures is associated with increased adhesions formation rate or not. A recent study revealed that the use of barbed suture [polyglyconate (V-Loc)] in uterine incision closure in the nonpregnant rat was associated with significantly higher adhesions scores and inflammatory cell scores compared with conventional smooth suture [polyglactin-910 (Vicryl)] [19]. On the other hand, Einarsson et al. [20] compared the use of barbed suture with traditional suture for uterine incision closure in a sheep model. ...
Article
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Introduction: The aim of this randomized control trial was to compare the operative data and the early postoperative outcomes of cesarean sections in which the uterine incision was closed with a barbed suture (STRATAFIX™ Spiral PDO Knotless Tissue Control Device, SXPD2B405, Ethicon Inc.) with those of cesarean sections in which the uterine incision was closed with a conventional smooth suture (VICRYL™; Ethicon Inc.). Materials and methods: One hundred pregnant patients were randomized in a 1:1 ratio to the Stratafix group or the Vicryl group. The uterine incision was closed by two layers of sutures in both groups. In the Vicryl group, the first layer was continuous and the second layer was interrupted. In the Stratafix group, both layers were continuous. Results: The uterine closure time was significantly lower in the Stratafix group (224 ± 46 versus 343 ± 75 s, p < .001). Operative time was comparable between both groups. Twelve patients in the Vicryl group and two patients in the Stratafix group required additional sutures to achieve hemostasis (p value = .009). The mean blood loss during closure of uterine incision and mean hospital stay were lower in the Stratafix group but these differences failed to reach statistical significance. Conclusion: The use of barbed suture for uterine incision closure at cesarean section is associated with shorter uterine closure time and similar early perioperative complications compared with conventional smooth suture. The difference between both groups in the technique of suturing the second layer of the uterine incision may be the cause of the reduction in the uterine closure time and the need for additional sutures to achieve hemostasis during suturing the uterine incision with a barbed suture. Further, well designed randomized controlled trials should be conducted to investigate the association between the type of suture (barbed or conventional smooth) and remote complications of cesarean section (infertility, pelvic pain, abnormal placentation and rupture uterus).
Article
Background: Urological repairs require secure suturing for effective healing. While conventional sutures like Vicryl are common, barbed sutures offer knotless options. This study aims to compare the histopathological effects of barbed and conventional sutures on the bladder. Method: Forty-eight adult Wistar female rats underwent bladder suturing with one of three suture materials: V-Loc™ 90, Quill™, or Vicryl. Each rat's anterior bladder wall was sutured with the designated material, and rats were sacrificed at 6- and 9-weeks post-surgery for histopathological evaluation. Tissue reaction, inflammatory reaction, fibrosis, and suture dissolution were assessed by a blinded pathologist. Results: Vicryl sutures showed significant reductions in tissue reaction, inflammatory reaction, and fibrosis from 6 to 9 weeks (p < 0.05). Quill sutures exhibited an increase in fibrosis over the same period (p < 0.001), while V-Loc sutures showed no significant changes. Comparative analysis revealed Vicryl had the best overall performance in terms of reduced tissue reaction and inflammation. Conclusions: Vicryl sutures demonstrated superior long-term histopathological outcomes compared to barbed sutures, indicating their potential preference for reconstructive bladder surgeries. Our findings emphasize the necessity of conducting additional studies on different anatomical tissues as well as refining suture selection for various surgical situations.
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The development and evaluation of synthesis materials are crucial to reducing the morbidity and magnitude of post‐enterorrhaphy surgical complications. Despite the possibility of production, chitosan thread has not yet been used in enterorrhaphy, and its effects on intestinal healing have not been evaluated. Therefore, this study aimed to evaluate the effects of chitosan thread on the intestinal wall repair of rabbits submitted to cecorrhaphy. For this, 42 rabbits were allocated into two groups with 21 animals. One group was submitted to cecorrhaphy with chitosan suture thread (CG) and the other with poliglecaprone suture thread (PG). The occurrence of postoperative complications, the intensity of edema, cellular response, formation of granulation tissue, as well as the deposition and maturation of collagen fibers, and the intensity of vascular endothelial growth factor (VEGF‐α) expression, were evaluated during the intestinal wall repair process. The evaluations occurred on the 5th, 15th, and 25th postoperative (PO) days. The animals did not develop peritonitis, but adherence was observed in six animals from CG and seven from PG, with no difference between groups. The polymorphonuclear infiltrate showed higher intensity and higher amount of type III collagen fibers in CG on the 15th PO day. In contrast, a lower amount of type I collagen fibers was observed in CG samples on the 25th PO day. Therefore, the chitosan thread used for cecorrhaphy in rabbits results in minimal postoperative complications, presents biocompatibility, and bioactively assists the tissue repair process of the cecal wall, inducing minimal tissue reaction, stimulating the deposition of type III collagen fibers in the proliferative phase, with sustained VEGF‐α expression, but with reduced deposition of type I fibers, indicating a delay in collagen maturation.
Article
Objective: The aim of this study was to determine whether robotic myomectomy (RM) resulted in any measurable clinical improvement over laparoscopic myomectomy (LM) in subsequent cesarean delivery. Materials and methods: The medical records of 273 patients who had undergone LM or RM followed by subsequent cesarean delivery for the period of September 2015 to December 2020 were retrospectively reviewed. The patients were divided into LM (n = 222) and RM (n = 51) groups. The cesarean delivery outcomes between the two groups were compared. Results: RM had significantly more myomas removed (6.0 ± 4.8 vs. 3.6 ± 3.5, p < 0.001) and a larger size of largest myoma (7.7 ± 2.4 vs. 6.1 ± 2.4, p = 0.002) at myomectomy compared with LM. However, there were no significant differences in the groups' surgical characteristics at cesarean section, in their pregnancy complications, or in adhesion formation. Conclusions: Although more and larger myomas were removed in the RM group, RM showed similar cesarean delivery outcomes and adhesion formation to LM.
Article
Objective: To determine differences in suture time and bursting strength on a longitudinal thelotomy closure using innovative barbed versus conventional smooth suture materials. Sample population: Twenty-four teats from 6 udders of culled beef cows. Study design: Experimental ex-vivo surgical study. Methods: Thelotomies (length: 2 cm) were performed on every teat and randomly allocated to closure with either a 3-0 bidirectional barbed suture for both mucosa and connective layers or a conventional 3-layer suture, using 3-0 smooth polydioxanone. For both groups, skin was closed with 2-0 polypropylene monofilament suture. Duration of suturing time for inner layers and bursting strength of the repair were recorded and compared. Results: Suturing was faster with barbed versus conventional sutures (527.7 ± 64.5 versus 727.1 ± 60.7 s, respectively; P < 0.0001). However, bursting strength was not significantly different between the 2 types of sutures. Conclusion: Using the barbed suture significantly reduced the time required to suture the mucosa and conjunctiva layers, with no significant difference between sutures in their bursting strength. Clinical significance: Bidirectional barbed suture material is suitable for closure of thelotomies in cattle.
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Background and objectives: Titanium DS clips are made to secure the appendiceal stump during laparoscopic appendectomy. The assumption is that they behave like stapler clips in the body, being made from titanium. However, the construction and weight of DS clips differs from staplers. Their biocompatibility may have implications for their clinical use. Methods: One hundred and twenty rats were randomized into four experimental groups: in the first group the appendiceal stump was secured by Vicryl® ligature, in the second by linear staplers, in the third by Hem-o-lok® plastic clips, and in the fourth by DS titanium clips. Ten animals from each group were sacrificed 7, 28, and 60 days post-surgery. Histopathological data and adhesion formation were assessed. Results: On postoperative day 7, a statistically significant difference was found in the occurrence of inflammation between the Hem-o-lok® and stapler groups. The adhesion score was significantly higher in the Vycril® and Hem-o-lok® in comparison to the DS and stapler groups. On postoperative day 28, a statistically significant difference was found in the occurrence of inflammation between the Vycril® and stapler groups. The adhesion score was significantly higher in the Vycril® than in the DS and stapler groups. On postoperative day 60, there were no statistical differences between any of the groups. The adhesion score was significantly higher in the Hem-o-lok® group in comparison to the DS and stapler groups. Conclusion: Staplers and DS clips have advantages over other methods of securing the appendiceal stump, because of their high biocompatibility and lower adhesion score.
Article
Aim: The aim of the study was to assess the incidence of postoperative adhesion by baseball running suture using barbed suture (BS) in laparoscopic myomectomy in comparison with sutures using an absorbable thread. Methods: Two hundred fifteen patients who underwent second-look laparoscopy (SLL) 6 months after laparoscopic myomectomy at our hospital between 2010 and 2014 were retrospectively reviewed. The incidence, numbers, types, and extent of adhesions were evaluated according to the more comprehensive adhesion scoring method. Propensity score matching (PS) (1:1) between the groups was performed by using the diameter of the largest myoma, the number of enucleated myomas, and the type of adhesion barrier. Results: Running baseball sutures and running sutures were applied to 28 and 187 patients with unidirectional BS and absorbable thread, respectively, to close the incised serosal wounds enucleating largest myomas during laparoscopic myomectomy. After PS matching for the patients, surgical findings and the incidence of postoperative wound adhesions were compared between the groups, including 22 patients each. The surgical findings were similar between the groups, except for the total surgical duration and blood loss (medians), which were significantly shorter and lower in the BS group than in the absorbable thread group (70 vs. 100 min; p = 0.01, 50 vs. 100 mL; p = 0.02). Regarding findings of SLL, no significant differences in the incidence of postoperative wound adhesions were found between the groups (BS, 4/22 [18.2%] versus absorbable thread, 8/22 [36.4%]; p = 0.31). Conclusion: Our data indicated that the incidence of postoperative adhesion following the use of BS for wound closure in laparoscopic myomectomy was similar to that following the use of conventional suture.
Article
Surgical adhesions can lead to significant consequences including abdomino-pelvic pain, bowel obstruction, subfertility, and subsequent surgery. Although laparoscopic surgery is associated with decreased risk of adhesion formation, methods to further decrease adhesions are warranted. We systematically reviewed literature addressing the management, prevention, and sequelae of adhesions in women undergoing laparoscopic gynecologic surgery. We searched PubMed, EMBASE, EBSCOhost, and CENTRAL and found 6566 records. The primary outcome was adhesion formation. The secondary outcomes were abdomino-pelvic pain, quality of life, subfertility, pregnancy, bowel obstruction, urinary symptoms, and subsequent surgery. After applying inclusion and exclusion criteria, 52 studies remained for qualitative synthesis. Risk of bias assessments were applied independently by two authors. There was evidence that Hyalobarrier® Gel, HyaRegen® NCH gel, Oxiplex®/AP Gel, SprayGel™, and Beriplast® all decrease the incidence of adhesions. Adept® significantly decreased de novo adhesion scores of the posterior uterus. Using an integrated treatment approach to pelvic pain significantly improved pain and quality of life as compared to standard laparoscopic treatment. Lastly, Hyalobarrier® Gel Endo placement led to a higher pregnancy rate than no barrier usage. Our findings underscore the need for high quality trials to evaluate the efficacy of surgical techniques, adhesion barriers, and other treatment modalities on management and prevention of adhesions and their clinical sequelae. This review was registered on PROSPERO (ID=CRD42017068053).
Article
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 as compared with continuous conventional smooth suture with intracorporeal knot. A randomized clinical trial (Canadian Task Force classification I). Tertiary hospital. Forty patients with unilateral ovarian endometrioma (3 to 10 cm in mean diameter) 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, USA) or conventional suture (Vicryl; Ethicon Inc, Sommerville, NJ, USA). Two layers of continuous sutures were used to control bleeding from the endometrioma bed and to reapproximate the ovarian edges. Degree of suturing difficulty was evaluated by the surgeons using a visual analogue scale (VAS) ranging from 1 to 10 (1 = least difficult suturing ; 10 = most difficult suturing).Operating time and suturing time were significantly shorter in the barbed suture group [43.3±10.5 vs. 52.8±9.69 min, P value = 0.005 and 8.85±2.52 vs. 15.7±4.12 min, P value < 0.001, respectively]. Suturing with barbed suture was less difficult than suturing with conventional suture [3.68±1.37 vs. 4.77±1.56, P value = 0.025]. Intraoperative blood loss was similar in both groups. No perioperative complications were reported in either group. A non-significant 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 value = 0.252 and 2.76±1.48 vs. 2.13±1.14 ng/ml, P value = 0.139, respectively]. The rates of decline in serum AMH levels after the operation in the barbed suture group and the conventional suture group were 18.32% and 22.84% respectively. The unidirectional knotless barbed suture (V-Loc) facilitates suturing of endometrioma bed after laparoscopic excision of ovarian endometrioma. When compared with conventional smooth suture (Vicryl), unidirectional barbed suture reduces the time needed to suture the endometrioma bed and the total operating time.
Article
Objectives: To compare surgical outcomes of different types of intracorporeal sutures for laparoscopic posterior myomectomy, by a prospective randomized study. Study design: Prospective randomized study on 47 patients with single posterior intramural myoma (4-7cm in diameter) undergoing laparoscopic myomectomy. The patients enrolled were divided into two groups, one operated using conventional suture in double strand, and the other with bidirectional barbed suture Stratafix. The main outcome measures were suturing time, peri-operative variables, and post-operative adhesions in both groups. Results: The mean operative time was shorter with the Stratafix™ than with the conventional suture (66.3±8.2 vs. 73±8min; p=0.005). Suturing time was significantly shorter in the Stratafix™ than in the control group (8.8±2.4 vs. 15.5±2.8min; p=0.001). Intraoperative bleeding was significantly less in the Stratafix group (p=0.0012). Conversely, there was no statistically significant difference for postoperative adhesions between the two groups (26.7% vs. 21.4% p=0.5). Conclusions: The use of barbed suture may reduce operative time, suturing time, and blood loss. No difference in post operative adhesions was found.
Article
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Aim: To summarize the most common etiologic factors and describe the pathophysiology in the formation of peritoneal adhesions, to outline their clinical significance and consequences, and to evaluate the pharmacologic, mechanical, and surgical adjuvant strategies to minimize peritoneal adhesion formation. Methods: We performed an extensive MEDLINE search of the internationally published English literature of all medical and epidemiological journal articles, textbooks, scientific reports, and scientific journals from 1940 to 1997. We also reviewed reference lists in all the articles retrieved in the search as well as those of major texts regarding intraperitoneal postsurgical adhesion formation. All sources identified were reviewed with particular attention to risk factors, pathophysiology, clinical manifestations, various methods, and innovative techniques for effectively and safely reducing the formation of postsurgical adhesions. Results: The formation of postoperative peritoneal adhesions is an important complication following gynecological and general abdominal surgery, leading to clinical and significant economical consequences. Adhesion occur in more than 90&percnt; of the patients following major abdominal surgery and in 55–100&percnt; of the women undergoing pelvic surgery. Small-bowel obstruction, infertility, chronic abdominal and pelvic pain, and difficult reoperative surgery are the most common consequences of peritoneal adhesions. Despite elaborate efforts to develop effective strategies to reduce or prevent adhesions, their formation remains a frequent occurrence after abdominal surgery. Conclusions: Until additional information and findings from future clinical investigations exist, only a meticulous surgical technique can be advocated in order to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery.
Article
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To estimate the safety and effectiveness of unidirectional knotless barbed suture compared to the traditional suture for repair of uterine wall defects through myomectomy via mini-laparotomy. This was a prospective clinical study performed by a single surgeon in a medical center. Sixty-eight women with symptomatic myoma were enrolled. Their uterine wall defects were repaired either by unidirectional knotless barbed suture (Group A) or by traditional suture (Group B). The surgical time, intraoperative blood loss, and number of myomas in the two groups were analyzed by two-sample t test. Surgical time required from skin incision to complete closure was significantly lower in Group A than in Group B (50.2 ± 16.49 vs. 69.1 ± 25.33 min) (p = 0.0008). The intraoperative blood loss was also lower in Group A (mean, 260.9 mL; range, 20-850 mL) than in Group B (mean, 394.7 mL; range, 50-2200 mL) but not statistically significant. The unidirectional knotless barbed suture may facilitate the repair of uterine defects during mini-laparotomy myomectomy by significantly lowering operative time. It may also reduce the intraoperative blood loss.
Article
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To verify the frequency of postsurgical pelvic adhesion formation in an experimental animal model using videolaparoscopy. Experimental study in a sample of 11 non-pregnant female rabbits, aged 5 to 7 months. After general anesthesia, access to the abdominal cavity was performed by an open puncture technique, with 10mm optics, placing two other 5 mm trochars under direct visualization, in the iliac fossae. Then a fragment of peritoneum was resected, followed by electrocauterization. In 21 days, the videolaparoscopy was repeated, and adhesion formation and score was looked at, with biopsies at the surgical site. 54 % of adhesion formation was observed, and the median score of adhesions was 6 (minimum of 3 and maximum of 10), all of them found in the bladder and the anterior abdominal wall. The method used presents a high frequency of intra-abdominal adhesion formation.
Article
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Peritoneal closure is a controversial issue among obstetricians and gynaecologists. This article reappraises the issue of peritoneal closure. We conducted a thorough literature search using Medline, Pubmed and Embase as well as a hand-search for all references quoted in the relevant papers. The routine non-closure of the peritoneum reduces operation time by an average of 6 min. Most studies showed no difference in the other outcome measures including infection/febrile episodes, analgesic/anaesthetics requirement, bowel function restoration, post-operative stay and adhesion formation. There are insufficient data concerning adhesion formation. In conclusion, apart from a slightly shorter operation time associated with non-closure of the peritoneum, many studies showed no difference in short-term morbidity in the closure and the non-closure group. More studies are needed to examine the long-term morbidity associated with the closure or the non-closure of the peritoneum.
Article
To investigate factors with pelvic adhesions and the effect of different degrees pelvic adhesions on fallopian tube recanalization in infertile patients. Total of 527 infertile patients undergoing hysteroscopy and laparoscopic surgery in Affiliated Hospital of Chinese People's Armed Police Forces Logistics College were studied retrospectively. According to the extent of pelvic adhesions, tubal umbrella adhesions and atresia, 377 cases were classified into adhesion groups, including 73 cases in grade I, 221 cases in grade II, 75 cases in grade III and 8 cases in grade IV based on adhesion score. The 150 cases with no obvious pelvic adhesion were matched as control group. Among 8 cases with grade IV ahesion were exluded from ahesion group the relationship between pelvic adhesions and related history, abdominal lesions, tubal patency and the prognosis were studied. (1) Related factors: the frequency of pelvic adhesion and more than 7 years of infertility of 23.9% (88/369) in adhesion group were significantly higher than 12.0% (18/150) in control groups. (2) History: compared with the control group (12.7%, 19/150; 28.7%, 43/150; 11.3%, 17/150; 12.0%, 18/150; 17.3%, 26/150), patients with pelvic adhesions present more incidence abortion (23.6%, 87/369), uterine cavity operation (38.2%, 141/369), ectopic pregnancy (20.9%, 77/369), pelvic inflammatory disease (25.5%, 94/369) and abdominopelvic surgery (31.4%, 116/369). (3) Endoscopy exploration: the incidence of hydrosalpinx (24.7%, 91/369), tube distorted (15.7%, 58/369) and salpingostomy (72.9%, 269/369) in adhesion group were higher than those in control group (2.0%, 3/150; 4.0%, 6/150; 12.0%, 18/150), but relatively lower incidence of pelvic endometriosis lesions (5.7%, 21/369) and mesosalpinx cysts (16.3%, 60/369) than those in control group (16.0%, 24/150; 30.0%, 45/150). The rate of proximal tubal recanalization (59.5%, 91/153) in adhesion group was lower than 75.4% (52/69) in control group. However, the rate of distant tubal recanalization of 84.4%, (281/333) in adhesion group and; 13/15 in control group didn't show statistical difference. (4) Prognosis: the rate of ectopic pregnancy of 9.7% (29/299) in adhesion group was significantly higher than 3.1% (4/128) in control group. Among cases with grade III adhesion exhibited the highest rate of ectopic pregnancy (13.0%, 7/54; OR = 4.62, 95%CI: 1.29 - 16.50). (5) Multivariate analysis: it was found that more than two drug abortions (OR = 3.29, 95%CI: 1.34 - 8.07), pelvic and(or) abdominal surgery history (OR = 2.20, 95%CI: 1.35 - 3.57) and pelvic inflammatory disease history (OR = 1.54, 95%CI: 1.21 - 1.97) were risk factors with pelvic adhesions. More than or equal to two drug abortion history, pelvic inflammatory disease and pelvic and abdominal surgery damage were important factors for pelvic adhesions of infertility patients, which may decrease the possibility of proximal tubal recanalization and increase ectopic pregnancy risk.
Article
To compare effectiveness, feasibility, and suturing time required between an absorbable barbed wire (V-Loc) uterine suture and a classic continuous suture with intracorporeal knots among women undergoing laparoscopic myomectomy. From January 2010 to February 2011, women with single symptomatic intramural myoma were prospectively enrolled in a single-center study at a university hospital in Rome, Italy. A control group with characteristics meeting the criteria for study inclusion was retrospectively identified from the hospital databases. In the prospective group uterine wall defects were closed with V-Loc suture, whereas in the control group they were closed by classical continuous suture with intracorporeal knots. Data were analyzed via Student t test, Mann-Whitney U test, and Fisher exact test. The mean operative time was shorter in the V-Loc (51±18.1 min) than in the control (58±17.8 min) group. Suturing time was significantly lower in the V-Loc than in the control (9.9±4.3 versus 15.8±4.7 min; P=0.0004) group. Both intraoperative bleeding and drop in hemoglobin were significantly lower in the V-Loc group (P=0.0076 and P=0.0176, respectively). Use of a barbed suture may aid surgeons during laparoscopic suturing by reducing operative time, suturing time, and blood loss.
Article
To compare cellular composition (fibroblasts vs. smooth muscle cells) and proliferation in uterine healing wounds after application of barbed compared with standard suture in a sheep model. Randomized trial (Canadian Task Force classification I) using each animal as its own control. Certified animal research facility. Population or sample. 23 non-pregnant ewes. A myometrial incision was created with the harmonic scalpel in each horn of the bicornuate uterus. The incisions were randomly allocated to be closed using either polyglactin 210 (Vicryl®) or barbed suture. Three months later, uterine tissues were collected, fixed and used for determination of cellular composition and proliferation using histochemistry (Masson trichrome staining) and immunohistochemistry (staining of smooth muscle cell actin and Ki67, a marker of proliferating cells) followed by image analysis. Evaluation and comparison of the cellular composition and proliferation of uterine wounds after application of barbed vs. standard suture. The ratio between connective tissue elements and smooth muscle cells, expression of smooth muscle cell actin and labeling index were similar in wounds after application of barbed compared with standard suture, but were different (p < 0.0001-0.05) in wounds than in non-wounded areas in uterus. Both barbed and standard sutures had similar effects on cellular composition and proliferation of uterine wounds in an animal model.
Article
To compare adhesion formation and ease of use of barbed vs traditional suture during myometrial closure in a sheep model. Randomized trial using each subject as its own control (Canadian Task Force classification I). Certified animal research facility. Twenty-three nonpregnant ewes. The Harmonic scalpel was used to create a myometrial incision in each uterine horn, and the incisions were randomly allocated to be closed using either polyglactin 210 (Vicryl) or barbed suture. Each animal served as its own control, with 1 horn sutured using barbed suture and the other horn sutured using Vicryl suture. Ease of use was evaluated by comparing closure times. Adhesion formation was compared at necropsy 3 months later using a standardized adhesion-formation scoring system. The evaluator of the adhesion score was blinded to the exposure at surgery. Mean total procedure time was 13.3 minutes. Myometrial closure was significantly faster using barbed vs traditional suture (126.5 seconds vs 272.6 seconds; p <.001). At necropsy 3 months later, adhesions were observed in 12 uterine horns (52.2%) in the barbed suture group vs 10 uterine horns (43.5%) in the Vicryl group (p = .62). The mean (SD) adhesion score was not significantly different between the barbed suture group (3.78 [3.92]) vs the Vicryl group (3.04 [3.75]) ( p = .16). Barbed suture significantly facilitates myometrial closure and is associated with adhesion formation and adhesion severity that is not different from that using Vicryl in an animal model.
Article
Surgical trends favor the minimally invasive approach for gynecologic procedures. Technology, equipment, and surgical materials have evolved to simplify technically challenging skills and decrease operative times to permit successful completion of procedures via the laparoscopic approach. However, with the introduction of new advances, surgeons must also be aware of potential complications that may arise. A barbed suture is an attractive suture option that allows for easier and faster laparoscopic suturing by eliminating repeated knots and the need to maintain tension on the suture line. Here we present the case of a small bowel obstruction caused by barbed suture used for vaginal cuff closure at the time of total laparoscopic hysterectomy. Implementation of a new technology or surgical material in laparoscopy to improve care must be optimized to prevent untoward events in our patients.
Article
As laparoscopic sacral colpopexy is associated with long operation times, barbed suture can be used to reduce the time needed to accomplish peritoneal closure. However, little is known about the adverse events of this new technique. We report on the case of a small bowel volvulus following peritoneal closure using a barbed suture. The patient presented with acute abdominal pain and a bowel obstruction syndrome 1 month after laparoscopic sacral colpopexy.
Article
To estimate the effectiveness of unidirectional knotless barbed suture and continuous suture with intracorporeal knots in the repair of uterine wall defects during laparoscopic myomectomy. Randomized clinical study (Canadian Task Force Classification I). Single-center study in a university hospital. This study enrolled 44 women who underwent laparoscopic myomectomy. In accord with to the randomization, the uterine wall defects were closed either with a continuous suture with intracorporeal knots (group V) or a unidirectional knotless barbed suture (group L). The time required to suture the uterine wall defect was significantly lower in group L (11.5 ± 4.1 minutes) than in group V (17.4 ± 3.8 minutes; p <.001). However, no significant difference was observed in the operative time between the 2 study groups. The intraoperative blood loss was significantly lower in group L than in group V (p =.004). The degree of surgical difficulty was significantly lower in group L (3.7 ± 1.1) than in group V (6.1 ± 2.1; p <.001). The unidirectional knotless barbed suture may facilitate the suture of uterine wall defects during laparoscopic myomectomy. When compared with continuous suture and intracorporeal knots, the barbed suture reduces the time required to suture the uterine wall defect and the intraoperative blood loss.
Article
To assess the biomechanical properties of full-thickness abdominal wall defects, either using Native tissues, with or without Overlay, and by substitution of the Defect by small intestinal submucosa mesh. Seventy-two rats were divided into three groups according to repair method (Native, Overlay or Defect). At 7, 14, 30, and 90 days, six rats were sacrificed to measure tensile strength, collagen ingrowth, and host response. Explants had comparable strength at 30 days, the majority rupturing at the interface. Afterwards, the Native group was more resistant than both small intestine submucosa (SIS) groups with a more organized fibrotic scar on histology at 90 days. SIS augmentation of native tissue repair does not increase strength. Replacement of abdominal wall by SIS is equally strong when compared to the SIS-augmented group; however, materials preferably rupture at the site of the implant itself.
Article
Polyglactic acid and polyglycolic acid suture materials were compared in rat uterine and abdominal wall tissues for inflammatory response and tissue fibrosis. By 90 days after surgery, the tissue inflammatory reaction and fibrosis were significantly less in response to polyglactic acid suture (Vicryl) in both uterus and skin as compared with the response to polyglycolic acid (Dexon). In addition, the over-all tissue response in skin was significantly greater than that in uterus for both suture materials. The potential importance of tissue fibrosis--particularly in oviductal surgery, over and above the formation of adhesions between one organ and another--is emphasized. It is concluded that (1) the magnitude of tissue response to suture material varies for different tissues, (2) the degree of tissue wall fibrosis does not necessarily correspond to external tissue adhesions, (3) adhesions are maximal at the surgical knots regardless of the suture material used, and (4) polyglactic acid suture material may be preferable to polyglycolic acid suture material for infertility surgery, in which a minimum of tissue reaction is imperative.
Article
One hundred and sixty tubal reconstructions were analyzed according to a classification which describes the type of tubal repair and the tubal segment treated. The results in 80 women who were operated upon just prior to the application of microsurgical principles were compared with those in 80 women in whom these techniques were employed. In expressing the results, no patients were excluded for any reason. Anatomical patency was not evaluated, and functional patency was measured by conception (abortion, tubal, or term pregnancy). Of the 80 women who had tuboplasty with conventional surgery, 10 (12.5%) successfully delivered at term, but 14 (17%) had tubal gestations. Almost 28% of the women (22) had successful pregnancies after microsurgery, but in 9 (11%) extrauterine pregnancies resulted. The three women with current intrauterine pregnancies could improve the microsurgical series to 31% successful pregnancies. Our initial experience with microsurgical techniques seems to show an increased number of term pregnancies, principally in patients who have undergone anastomosis.
Article
A microsurgical technique for anastomosis of the oviduct is described using the rabbit as an animal model. A control group of five previously sterilized rabbits had both oviducts rejoined and all became pregnant. Another three groups of animals had a reanastomosis immediately after division of both oviducts. One oviduct was later removed for histological study and the animals were subsequently mated. Twenty-three out of 25 (92 per cent) conceived and delivered a normal litter after repair of the oviduct with very fine nylon sutures without postoperative splinting; only seven out of 15 (46.7 per cent) delivered after catgut sutures had been used without splinting and only 9 out of 20 (45 per cent) delivered when nylon sutures and prolonged splinting were associated with increased fibrosis, adhesion formation and poor healing of the anastomosis.
Article
In an attempt to evaluate the efficacy of salpingoovariolysis we studied 147 women who were found to have periadnexal adhesions on laparoscopic examination. Among these women, 69 were treated by laparotomy and salpingoovariolysis and 78 were not treated. There was no significant difference between the degree of adhesions in the treated group and in the nontreated group. With the use of life table analysis, the cumulative pregnancy rate at 12 and 24 months follow-up was 32% and 45% in the treated group and 11% and 16% in the nontreated group, respectively (p less than 10(-6)). We suggest that although pregnancy might occur in infertile women who have periadnexal adhesions, treatment with salpingoovariolysis is associated with a higher pregnancy rate.
Article
Long- and short-term reactions of reproductive tract tissue to microsurgical suture materials were compared. The five materials were: polyglactin 910 (Vicryl), polyglycolic acid (Dexon-S), polypropylene (Prolene), nylon (Ethilon and Dermalon) and chromic catgut; the calibers ranged from 6-0 to 10-0. Sixteen days after suture placement the smallest tissue reaction was seen with 9-0 and 10-0 suture materials; Dexon-S caused a slightly greater reaction than did Vicryl. Prolene, 8-0 and 9-0, produced the smallest tissue response when compared to other sutures of similar size. Larger sutures incited greater tissue reactions. Forty-two days after placement, each suture was associated with similar or lower reaction scores than those observed at 16 days. At 90 days all the Dexon-S sutures had been absorbed. Vicryl had less of a late reaction as compared to the other sutures. Reactions persisted longer with nonabsorbable suture, and the tissue response depended on both the suture material and caliber. Vicryl, 8-0 to 10-0, incited the smallest short- and long-term tissue reaction; at those sizes it seems optimal for reconstructive tubal surgery.
Article
A suture material associated with a minimal inflammatory response might be expected to induce less frequent and less severe peritoneal adhesions. A comparison between polydioxanone and polyglactin 910 suture was performed in a rabbit model. Ten sexually mature virgin female New Zealand white rabbits underwent laparotomy and bilateral incisions into the distal uterine cavities. The serosa of the left uterine horn was always reapproximated with polyglactin 910 suture whereas the right uterine horn was repaired with polydioxanone suture. All animals were put to death 28 days later. An adhesion score was given for each uterine horn. Representative sections were obtained for histologic review. Similar histologic responses were found in both groups. No significant difference was noted in adhesion scores between the two sutures. The present study cannot justify the use of one of these sutures over the other with regard to adhesion formation or tissue reaction.
Article
Histologic reaction to nylon, polypropylene, polyglactin-910, and polydioxanone microsutures was assessed in the uterine horn of the rabbit. At 24 days after insertion of the microsuture, a marked infiltration of histiocytes was seen around the nylon, polypropylene, and polydioxanone microsutures, whereas the reaction to polyglactin-910 was characterized by the presence of giant cells. At 80 days after insertion of the microsutures, the polydioxanone was almost entirely absorbed and the reaction to polyglactin-910 was minimal. Moderate histiocytic infiltration persisted around the nylon and polypropylene sutures. Fibrosis was also detected around the nylon and polypropylene sutures at 80 days, but not at all around the polydioxanone and polyglactin-910 sutures. We conclude that polydioxanone leaves little or no tissue reaction at 80 days in the uterine horn of the rabbit.
Article
A reproducible and semiquantitative rat model for the evaluation of therapeutic modalities used for the prevention of postoperative adhesion formation is designed within three experiments. In all experiments, a standard peritoneal defect was excised, sutured and adhesion formation was evaluated after 2 weeks according to the extent. Variation in extent of adhesions and type of tissue involved depended on the experimental design. While neither cecum nor colon descendens participated in the adhesions after a clamping trauma, the uterine horn was found to participate in almost all cases, especially when sutured proximally and distally to the peritoneal defect. The peritoneal defect/uterine horn model proved to be valid and reproducible and allowed a semiquantitative scoring. Additionally, the amount of blood loss as graded did not influence the presented rat adhesion model.
Article
Adhesion formation after abdominal operations causes significant morbidity. Adhesion formation in pigs was compared after placement of prosthetic mesh during celiotomy (group 1), laparoscopy with large incision (group 2), and laparoscopy (group 3). After peritoneum was excised, polypropylene mesh was fixed to the abdominal wall, then to the opposite abdominal wall in the preperitoneal space followed by peritoneal closure. Adhesion area, grade, and vascularity were measured. More adhesions (p < 0.02) covered intraperitoneal mesh (7.57 +/- 1.89 cm2) than covered reperitonealized mesh (2.16 +/- 1.13 cm2), and adhesion grade was significantly greater (p < 0.02). Adhesion areas were significantly greater in groups 1 and 2 than in group 3 (p = 0.001 and 0.03, respectively). Adhesion grade was significantly greater in groups 1 and 2 than in group 3 (p = 0.02 and p = 0.04, respectively). Groups 1 and 2 had more vascular adhesions than group 3 (p < 0.01 and p = 0.02, respectively) A foreign body within the peritoneum stimulates more numerous and denser adhesions. Tissue trauma distant from the site of adhesions increases their formation. A major advantage of laparoscopic surgery is decreased adhesion formation.
Article
Our purpose was to evaluate a possible relationship between adhesion-related small-bowel obstruction and gynecologic operations. The records of all female patients with the diagnosis of small-bowel obstruction from 1989 to 1996 were studied. The cause of bowel obstruction, the type and technique of previous operations, and whether the parietal peritoneum was closed at the completion of the procedure or was left open were evaluated. Among 262 women the most common cause of small-bowel obstruction was intra-abdominal adhesions (37.0%). Among 92 women with adhesion-related small-bowel obstruction, 35 women (38%) had undergone a previous abdominal hysterectomy. The incidence of small-bowel obstruction after an abdominal hysterectomy was 16.3 per 1000 hysterectomies. The incidence of small-bowel obstruction after cesarean delivery (5/10,000 cesarean deliveries) was significantly less than after other abdominal operations. Adhesions were found between the small bowel and the pelvis in 14 women (29.8%), and all were in women who had undergone a hysterectomy. In 33 others (70.2%) the adhesions were found between the previous abdominal incision and the intestine. The median interval between the initial operation and the small-bowel obstruction was 5.3 years. The most common cause of small-bowel obstruction is postsurgical adhesions. Adhesionrelated small-bowel obstruction is commonly found after an abdominal hysterectomy. Bowel obstruction can occur many years after the initial abdominal surgery.
Article
To summarize the most common etiologic factors and describe the pathophysiology in the formation of peritoneal adhesions, to outline their clinical significance and consequences, and to evaluate the pharmacologic, mechanical, and surgical adjuvant strategies to minimize peritoneal adhesion formation. We performed an extensive MEDLINE search of the internationally published English literature of all medical and epidemiological journal articles, textbooks, scientific reports, and scientific journals from 1940 to 1997. We also reviewed reference lists in all the articles retrieved in the search as well as those of major texts regarding intraperitoneal postsurgical adhesion formation. All sources identified were reviewed with particular attention to risk factors, pathophysiology, clinical manifestations, various methods, and innovative techniques for effectively and safely reducing the formation of postsurgical adhesions. The formation of postoperative peritoneal adhesions is an important complication following gynecological and general abdominal surgery, leading to clinical and significant economical consequences. Adhesion occur in more than 90% of the patients following major abdominal surgery and in 55-100% of the women undergoing pelvic surgery. Small-bowel obstruction, infertility, chronic abdominal and pelvic pain, and difficult reoperative surgery are the most common consequences of peritoneal adhesions. Despite elaborate efforts to develop effective strategies to reduce or prevent adhesions, their formation remains a frequent occurrence after abdominal surgery. Until additional information and findings from future clinical investigations exist, only a meticulous surgical technique can be advocated in order to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery.
Article
Adhesion development can have a major impact on a patient's subsequent health. Adhesions are a significant source of impaired organ functioning, decreased fertility, bowel obstruction, difficult re-operation, and possibly pain. Consequently, their financial sequelae are also extraordinary, with more than one billion dollars spent in the USA in 1994 on the bowel obstruction component alone. Performing adhesiolysis for pain relief appears efficacious in certain subsets of women. Unfortunately even when lysed, adhesions have a great propensity to reform. Adhesions are prevalent in all surgical fields, and nearly any compartment of the body. For treatment of infertility and recurrent pregnancy loss, lysis of intrauterine adhesions results in improved fecundability and decreased pregnancy loss.
The use of a new sythetic absorbable monofilament suture, polydiaxanone (PDS), for surgery.
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DeCherney A, Laufer N. The use of a new sythetic absorbable monofilament suture, polydiaxanone (PDS), for surgery. Fertil Steril 1983;39:401.
polydiaxanone (PDS), for surgery
suture, polydiaxanone (PDS), for surgery. Fertil Steril 1983;39:401. 346
  • Management Vention
vention and management. Dig Surg 2001;18:260–73. 303
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