Suture for Gastropexy: Time to Engage Barbs?

Prophylactic gastropexy reduces the incidence and recurrence rate of life-threatening gastric dilatation-volvulus (GDV). New suture materials have decreased surgical time in human laparoscopic surgery. The objective of this controlled clinical trial was to compare laparoscopic gastropexy using traditional intracorporeal knots versus 2 types of self-anchoring barbed sutures (Quill; V-Loc) with barbs that engage the tissue and thus do not require knot tying.

Thirty dogs weighing over 16 kg were randomly assigned to 1 of 3 laparoscopic gastropexy groups: group 1 (control) with intracorporeal 2-0 polydioxanone sutures; group 2 with 0 Quill barbed sutures; and group 3 with 2-0 V-Loc barbed sutures. Mean gastropexy suturing time was significantly longer for group 1 (36 min) than for groups 2 (20 min) and 3 (19 min). Total surgery time was also significantly longer for group 1. There were no significant complications in any group. Follow-up ultrasonography at 1, 3, and 6 months postoperatively—as well as laparoscopic examination of 1 dog each from groups 2 and 3 at 6 months—confirmed that all gastropexies remained intact.

Commentary

Laparoscopic gastropexies have been performed in the U.S. for more than 13 years for GDV prevention. For many of those years, suturing outside of the body was easier than cumbersome knot tying inside the abdomen. In this experiment, equivalent sutures from 3 different companies were compared, with only 1 of them requiring a knot. All gastropexies healed well, no major complications occurred, and all clients were satisfied and would recommend the procedure to a friend.

Based on this study, the barbed, knotless suture provided for a quicker surgery than the traditional suture with knots, seemingly with no downside. The barbs held the tissue well, but meticulous placement is important to avoid penetrating the gastric lumen. My experience with barbed sutures is positive.—Jonathan Miller, DVM, MS, DACVS

Source

Evaluation of two novel self-anchoring barbed sutures in a prophylactic laparoscopic gastropexy compared with intracorporeal tied knots. Spah CE, Elkins AD, Wehrenberg A, et al. VET SURG 42:932-942, 2013.