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Barbed sutures in robotic RYGB

Self-fixing barbed sutures in robotic RYGB is safe

In all procedures, a linear stapled, side-to-side gastrojejunostomy was performed and the enterotomy was completed with a running resorbable unidirectional barbed suture

Using self-fixing barbed sutures in robotic Roux-en-Y bypass (RYGB) surgery is safe and enables the robotic surgeon to perform a simple continuous suture without the need for recurrent retraction, according to researchers from Germany. Although the results from this small study were positive, the authors stated that additional studies with a higher level of evidence are required.

The paper, ‘Use of barbed sutures in robotic bariatric bypass surgery: a single-center case series’, published in BMC Surgery, by researchers from the University Hospital Schleswig Holstein, Kiel, Germany, sought to assess whether barbed sutures can be used safely in robotic RYGB surgery.

In this single-centre, single-surgeon case series, the researchers included 50 RYGB procedures using the da Vinci Xi Surgical System in combination with the use of barbed sutures from August 2017 to September 2018.  Of the 50 RYGB procedures with the da Vinci Xi Surgical System using unidirectional Stratafix sutures - 37 were primary proximal RYGB surgeries and 13 were performed as redo procedures (four were proximal RYGB and nine were distal RYGB operations).

The number of procedures performed, gender, age at surgery, preoperative weight, BMI, and Edmonton obesity staging system were collected and the duration of surgery, console time, length of hospital stay, percentage weight loss, number of revision surgeries and complications within the first 30 days were recorded.

In all procedures, a linear stapled, side-to-side gastrojejunostomy was performed and the enterotomy was completed with a running resorbable unidirectional barbed suture (Stratafix 2-0). The researchers explained that the self-fixing barbed suture material makes the laparoscopic knot obsolete and provides constant thread tension after a single tightening of the barbed suture material.


The researchers revealed that there were no complications during surgery - all running sutures for closing the enterotomy were performed without any problems and there were no ruptures of the thread. The average operation time was 127 minutes.

Thirty days after surgery, the mean ± standard deviation excess weight loss of 21.9±7.5% was recorded after proximal gastric bypass. Ideal body weight was calculated as that equivalent to a BMI25.

One patient had abnormal infection parameters caused by partial omentum necrosis (after proximal RYGB) and the patient had a revision operation was performed. A second patient was readmitted 12 days after proximal RYGB with gastrointestinal bleeding and they were treated conservatively. There were no other higher-grade complications, in particular no anastomotic insufficiencies and no stenosis.

“Whether the use of barbed sutures has advantages over conventional sutures cannot be answered by this study. Furthermore, the case series does not allow a statement on cost efficiency, time efficiency, or effects on the learning curve,” they concluded. “The results of our study indicate that use of self-fixing barbed sutures in performing intestinal anastomosis during the robotic RYGB is safe and appropriate. Further studies with higher evidence levels are required.”

To access this paper, please click here

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