Totally hand-sewn anastomosis using barbed suture device during laparoscopic gastric bypass in obese. A feasibility study and preliminary results

Introduction: Barbed sutures are routinely used for laparotomy, peritoneal and mesenteric closure, but few studies have reported their use for intestinal anastomosis. We proposed their use for totally hand-sewn anastomosis during laparoscopic gastric bypass secured at the end of the suture with an absorbable clip. Materials and Method: Two totally hand-sewn single-layer extramucosal running sutures were performed for side-to-side gastrojejunal and jejuno-jejunal anastomosis during laparoscopic gastric bypass. Each run (anterior and posterior layer) was locked at the end by an absorbable poly-p-dioxanone suture clip. Results: A total of 96 hand-sewn anastomoses were performed. A total of two leaks occurred originating from the jejunaljejunal anastomosis. No cases of leakage from gastrojejunostomy were recorded. Two stenoses of the gastrojejunal anastomosis were recorded. They were successfully treated with three sessions of endoscopic balloon dilatation. No bleeding occurred. Conclusion: In our experience, the suture-related complication rate is comparable with the data reported in the literature. Further studies are needed to address the safety and efficacy of the self-maintained suture in digestive surgery.