Advances in Clinical and Experimental Medicine
2019, vol. 28, nr 5, May, p. 643–649
Publication type: original article
Do barbed sutures with different surface textures have different effects on adhesion formation and histological features? An experimental blinded study in an animal model
1 Department of Obstetrics and Gynecology, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Turkey
2 Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
3 Department of Obstetrics and Gynecology, Acıbadem University, Altunizade Hospital, Istanbul, Turkey
Background. The obstetrics and gynecology literature has expanded in recent years to include clinical trials assessing the use of barbed sutures. The difficulty of intracorporeal suturing continues to be a barrier to a wider use of laparoscopy. Although the use of barbed sutures has been shown to ease the process of laparoscopic suturing considerably, concerns have been raised regarding a potentially increased risk of adhesions or inflammation as a result of their use.
Objectives. The aim of this study was to determine whether differences in surface textures, resulting from the variations in the geometric configurations of barbs, lead to differences in intra-abdominal adhesion formation.
Material and Methods. A total of 27 non-pregnant female Wistar Hannover rats, weighing 200–250 g, with intact uteri were used as an adhesion formation model. The rats were randomly assigned to 3 groups: barbed suture group 1, barbed suture group 2 and control group (no intracorporeal suture). A 2-centimeter vertical incision was performed on the anti-mesosalpingeal side of one of the uterine horns. The incision on the uterine horn was reapproximated with a running suture, entailing 3 needle punctures and left untied at one end. Six weeks after the operation, intra-abdominal adhesion formations were investigated both clinically and histopathologically.
Results. Clinical adhesion scores and histopathological parameters in both the barbed suture groups were statistically significantly higher than in the control group (p < 0.05). There was no significant difference between the barbed suture groups regarding the adhesion scores.
Conclusion. The 2 types of barbed sutures with different surface textures, used for myometrial closure, form a similar profile with respect to postoperative adhesion formation.
adhesion formation, barbed suture, knotless suture, myometrial closure, smooth suture
- Greenberg JA. The use of barbed sutures in obstetrics and gynecology. Rev Obstet Gynecol. 2010;3(3):82–91.
- Greenberg JA, Goldman RH. Barbed suture: A review of the technology and clinical uses in obstetrics and gynecology. Rev Obstet Gynecol. 2013;6(3–4):107–115.
- Jordan MC, Hölscher-Doht S, Jakubietz MG, Jakubietz G, Meffert RH, Schmidt K. Suture material for flexor tendon repair: 3-0 V-Loc versus 3-0 Stratafix in a biomechanical comparison ex vivo. J Orthop Surg Res. 2014;9:72.
- Tulandi T, Einarsson JI. The use of barbed suture for laparoscopic hysterectomy and myomectomy: A systematic review and meta-analysis. J Minim Invasive Gynecol. 2014;21(2):210–216.
- Greenberg JA, Einarsson JI. The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy. J Minim Invasive Gynecol. 2008;15(5):621–623.
- Burchett MA, Mattar SG, McKenna DT. Iatrogenic intestinal and mesenteric injuries with small bowel volvulus following use of barbed suture during laparoscopic myomectomy. J Laparoendosc Adv Surg Tech A. 2013;23(7):632–634.
- Thubert T, Pourcher G, Deffieux X. Small bowel volvulus following peritoneal closure using absorbable knotless device during laparoscopic sacral colpopexy. Int Urogynecol J. 2011;22(6):761–763.
- Donnellan NM, Mansuria SM. Small bowel obstruction resulting from laparoscopic vaginal cuff closure with a barbed suture. J Minim Invasive Gynecol. 2011;18(4):528–530.
- Api M, Boza A, Cikman MS, Aker FV, Onenerk M. Comparison of barbed and conventional sutures in adhesion formation and histological features in a rat myomectomy model: Randomized single blind controlled trial. Eur J Obstet Gynecol Reprod Biol. 2015;185:121–125.
- Neff MR, Holtz GL, Betsill WL. Adhesion formation and histologic reaction with polydioxanone and polyglactin suture. Am J Obstet Gynecol. 1985;151(1):20–23.
- Leach RE, Burns JW, Dawe EJ, SmithBarbour MD, Diamond MP. Reduction of postsurgical adhesion formation in the rabbit uterine horn model with use of hyaluronate/carboxymethylcellulose gel. Fertil Steril. 1998;69(3):415–418.
- Hooker GD, Taylor BM, Driman DK. Prevention of adhesion formation with use of sodium hyaluronate-based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh: A randomized, controlled study. Surgery. 1999;125(2):211–216.
- Api M, Cikman MS, Boza A, Rabus MB, Onenerk M, Aker FV. Peritoneal closure over barbed suture to prevent adhesions: A randomized controlled trial in an animal model. J Minim Invasive Gynecol. 2015; 22(4):619–625.
- Zaruby J, Gingras K, Taylor J, Maul D. An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure: Biomechanical wound strength and histology. Aesthetic Surg J. 2011;31(2):232–240.
- Einarsson JI, Vonnahme KA, Sandberg EM, Grazul-Bilska AT. Barbed compared with standard suture: Effects on cellular composition and proliferation of the healing wound in the ovine uterus. Acta Obstet Gynecol Scand. 2012;91(5):613–619.
- Einarsson JI, Grazul-Bilska AT, Vonnahme KA. Barbed vs standard suture: Randomized single-blinded comparison of adhesion formation and ease of use in an animal model. J Minim Invasive Gynecol. 2011;18(6):716–719.
- Petrut B, Hogea M, Fetica B, et al. In-vivo assessment of barbed suturing thread with regard to tissue reaction and material absorption in a rat model. Clujul Med. 2013;86(4):371–376.
- Dennis C, Sethu S, Nayak S, Mohan L, Morsi Y, Manivasagam G. Suture materials: Current and emerging trends. J Biomed Mater Res. 2016; 104(6):1544–1549.
- Greenberg JA, Clark RM. Advances in suture material for obstetric and gynecologic surgery. Rev Obstet Gynecol. 2009;2(3):146–158.