Esther F Ferrero-CelemÃn1, Angel Cuadrado-GarcÃa1, Jose Daniel Sanchez-Lopez1, Luis GarcÃa-Sancho1, Sara Núñez-O´Sullivan2, Mariana GarcÃa-Virosta1, Federico Del Castillo- DÃez3, Luis Antonio Picardo-Nieto1. 1Hospital Universitario Infanta SofÃa. San Sebastian de los Reyes. Madrid. Spain, 2Hospital Infanta SofÃa. Madrid. Spain, 3Hospital Universitario La Paz. Madrid. Spain
Objective of the technology: The aim of the use of the irreabsorbable barbed suture in the Nissen fundoplication is to shorten the surgical times, which would achieve benefits for the patient and the institution, increasing the number of ambulant patients and the number of patients to be operated the same surgical session.
Description of the technology and method of its use or application: The patient is placed in french position. We introduce 5 supraumbilical 5mm trocars. We performed a wide dissection of the hiatus and the distal esophagus until sufficient esophagus was obtained in the abdominal cavity so that the fundoplication did not ascend to the thorax, respecting the vagal branches. The hiatorraphy is then carried out with an irreabsorbable barbed suture, continuously and without making intracorporeal knots. The 360?° fundoplication is then performed, wrapping the esophagus with the fundus and stitching it with irreabsorbable continuous barbed suture and without intracorporeal knots. We cut out short vessels if necessary so that the fundoplication is not under tension. Both the hiatorraphy and the fundoplication are calibrated with a 12Fr Foucher tube. In all patients the fundoplication should be high, short (2-4cm) and floppy, as we did before the use of this new material. While performing the fundoplication we usually fix it to the esophagus with one of the points to reduce the risk of migration and torsion of the valve.
Preliminary results: A pilot study of the first 45 cases of Nissen fundoplication with barbed suture was performed between January 2015 and December 2018. Choosing of suture is done by surgeon's preferences. The average age was 52.84 years, 25 women (54.35%) and 21 men (45.65%).
In 2015, 5% of the Nissen fundoplications were carried out with barbed suture, in 2016 36%, in 2017 50%, while in 2018 this material was used in 100% of the cases.
We did not have intraoperative or postoperative complications in relation to the use of barbed suture. We have shortened our surgical times so we can perform more procedures and decrease the surgical waiting list. Average operating times: barbed suture: 40min not barbed: 50min.
The average hospital stay of the patients was: barbed suture 1.3 days (40% was performed on an outpatient basis within a protocol accepted by our hospital).
4 patients have again symptoms of gastroesophageal reflux without pathological pHmetry, one patient had to be reoperated for dysphagia but it was an 85 year old patient with esophageal motor disorder who had to undo the Nissen and perform another technique, so that we assume that the cause was not the barbed suture but the technique used.
Conclusions / future directions: Barbed suture is safe, easy to use and since it does not need intracorporeal knots, it makes the surgery faster. The increase in its use in our hospital is related to the absence of complications, good short-term results, easy reproducibility and shortening of surgical time.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98840
Program Number: ETP741
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster