Unidirectional Barbed Sutures as a Novel Technique for Laparoscopic Ventral Hernia Repair

David Nguyen, MD, Samuel Szomstein, MD, FACS, FASMBS, Fernando Dip, MD, Meenakshi Rajan, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Background

Incisional hernias remain a significant complication of abdominal surgeries. Laparoscopic repair of ventral hernias is widely accepted as feasible and cost-effective. Primary closure of the hernia defect has demonstrated to be beneficial in the long-term outcome. However, this can be technically challenging and time consuming. This study describes the use of non-absorbable suture with barbs in primary closure of hernia defects laparoscopically in addition to mesh as underlays.

Methods

Patients who underwent laparoscopic primary ventral hernia repair with mesh were prospectively collected. Two groups were defined: operations performed with barbed sutures for primary closure in addition to mesh and operations with only mesh without defect repair. The suturing time of defect repair with barbed sutures, total operative times, and the rate of hernia recurrence and complications in both groups were documented. The surgical technique involved running the hernia defect with a 2 polypropylene non-absorbable unidirectional barbed suture and subsequently fixing a mesh with tacks to underlay the closure.

Results

Twenty-eight cases with barbed suture and mesh utilization, and 29 cases with only mesh were identified. The longest dimension of the hernia defects was an average of 7.2±2.3 cm in length. Mean operating time was 48 minutes (range 35-187 minutes) in the barbed suture with mesh group. The mean suturing time of closing the ventral hernia defect was 16 minutes (11-24 minutes). In the mesh only group, mean operating was 41 minutes (34-155 minutes), p=0.4. There were no intraoperative adverse events in both groups. In patients with primary fascial closure with barbed sutures, mean follow-up was 9.8±1.3 months with no hernia recurrence.

Conclusion

The barbed suture closure system could be used for rapid and effective primary closure in laparoscopic ventral hernia repair with an additional mesh underlay. Further evidence to support these findings and longer follow-up periods are warranted to evaluate short- and long-term complications.