In Vivo Assessment of an Absorbable and Non-Absorbable Knotless Barbed Suture for Laparoscopic Single-Layer Enterotomy Closure: A Clinical and Biomechanical Comparison Against Non-Barbed Suture

Philip Omotosho, MD, Basil Yurcisin, MD, Eugene Ceppa, MD, Jeffrey Miller, MS, David Kirsch, MS, Dana Portenier, MD. Duke University Medical Center

Background: Laparoscopic intracorporeal suturing and knot tying is a complex skill that requires repeated deliberate practice to master. A novel self-anchoring barbed suture material that does not require knot tying can eliminate knot failure and reduce operating time. The goal of this study was to compare the in vivo efficacy of two novel knotless barbed sutures (absorbable and non-absorbable) for use with the Endo Stitch™ device (Covidien, Mansfield, MA), against conventional suture (Endo Stitch™ device with Polysorb™ suture, Covidien, Mansfield, MA) for laparoscopic closure of viscerotomies in canine stomach, jejunum, and colon. Methods: Following IACUC approval twenty-four dogs underwent laparoscopic creation of 25 mm viscerotomies, three each in the stomach, jejunum, and colon. All viscerotomies were closed with the Endo Stitch™ device using the absorbable or non-absorbable barbed suture or conventional suture. Closure time for each viscerotomy was recorded. Animals were survived for 3, 10, or 21 days, at which point the viscerotomies were burst-pressure tested. Results: The closure leak rate in this study with 216 total viscerotomy closures was 0%. There was no statistically significant difference in mean burst pressure between viscerotomies closed with barbed suture versus control suture at any of the survival intervals. Barbed suture with the Endo Stitch™ device was associated with statistically significantly faster closure times than the control suture with the Endo Stitch™ device (P<0.05) resulting in a reduction in closure time between 35-42%. Conclusion: This study reports the first use of barbed suture for the Endo Stitch™ device in laparoscopic gastrointestinal closure. The barbed suture for the Endo Stitch™ device is effective for laparoscopic single-layer gastrointestinal closure and is associated with a significantly reduced closure time.