Skip to main content
SpringerLink
Log in

Unidirectional barbed sutures as a novel technique for laparoscopic ventral hernia repair

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Incisional hernias remain a significant complication of abdominal surgeries. Primary closure of the hernia defect has been suggested to improve long-term abdominal wall function. However, this can be technically challenging and time consuming. This study describes laparoscopic use of non-absorbable barbed sutures in primary closure of hernia defects in addition to intraperitoneal mesh.

Methods

Patients who underwent laparoscopic primary ventral hernia repair with mesh were prospectively reviewed. 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 surgical technique involved running the hernia defect with a 2-polypropylene non-absorbable unidirectional barbed suture and subsequently fixing the mesh intraperitoneally with tacks. In both groups, a single transfascial centering suture was also utilized.

Results

Twenty-eight cases with barbed suture and mesh reinforcement and 29 cases with mesh-only were identified. The average dimensions of the ventral hernia defects were 57.8 (6–187) and 44.6 cm2 (9–156) in the barbed suture with mesh and mesh-only group, respectively, p = 0.23. Median operating time was 78 min (range 35–187 min) in the barbed suture with mesh group versus 62 min (34–155 min) in the mesh-only group, p = 0.44. The median suturing time of closing the ventral hernia defect was 16 min (11–24 min). There were no differences in the pain scores. Mean follow-up for both groups was 8.2 ± 3.6 months (1–17 months) with one hernia recurrence in the mesh-only group, p = 0.41.

Conclusions

The barbed suture closure system could be used for rapid and effective primary defect closure in laparoscopic ventral hernia repair in addition to intraperitoneal mesh placement. No significant difference in operating time was detected when compared to the mesh-only approach. Further evidence to support these findings and longer follow-up periods is warranted to evaluate short- and long-term complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251:843–856

    Article  PubMed  Google Scholar 

  2. Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858

    Article  CAS  PubMed  Google Scholar 

  3. Nguyen SQ, Divino CM, Buch KE, Schnur J, Weber KJ, Katz LB, Reiner MA, Aldoroty RA, Herron DM (2008) Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. JSLS 12:113–116

    PubMed Central  PubMed  Google Scholar 

  4. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399 (discussion 399-400)

    PubMed Central  PubMed  Google Scholar 

  5. Lyons C, Joseph R, Salas N, Reardon PR, Bass BL, Dunkin BJ (2012) Mesh fixation with a barbed anchor suture results in significantly less strangulation of the abdominal wall. Surg Endosc 26:1254–1257

    Article  PubMed  Google Scholar 

  6. Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119

    Article  CAS  PubMed  Google Scholar 

  7. Bauer JJ, Harris MT, Kreel I, Gelernt IM (1999) Twelve-year experience with expanded polytetrafluoroethylene in the repair of abdominal wall defects. Mt Sinai J Med 66:20–25

    CAS  PubMed  Google Scholar 

  8. Koller R, Miholic J, Jakl RJ (1997) Repair of incisional hernias with expanded polytetrafluoroethylene. Eur J Surg 163:261–266

    CAS  PubMed  Google Scholar 

  9. Misiakos EP, Machairas A, Patapis P, Liakakos T (2008) Laparoscopic ventral hernia repair: pros and cons compared with open hernia repair. JSLS 12:117–125

    PubMed Central  PubMed  Google Scholar 

  10. Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Trans-cutaneous Closure of Central Defects (TCCD) in laparoscopic ventral hernia repairs (LVHR). World J Surg 37:42–51

    Article  PubMed  Google Scholar 

  11. Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL (2007) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc 21:391–395

    Article  CAS  PubMed  Google Scholar 

  12. Zeichen MS, Lujan HJ, Mata WN, Maciel VH, Lee D, Jorge I, Plasencia G, Gomez E, Hernandez AM (2013) Closure versus non-closure of hernia defect during laparoscopic ventral hernia repair with mesh. Hernia 17:589–596

    Article  CAS  PubMed  Google Scholar 

  13. Alcamo J (1964) Surgical needle. US patent 3,123,077

  14. Villa MT, White LE, Alam M, Yoo SS, Walton RL (2008) Barbed sutures: a review of the literature. Plast Reconstr Surg 121:102e–108e

    Article  PubMed  Google Scholar 

  15. Bartlett LC (1985) Pressure necrosis is the primary cause of wound dehiscence. Can J Surg 28:27–30

    CAS  PubMed  Google Scholar 

  16. Simón-Allué R, Pérez-López P, Sotomayor S, Peña E, Pascual G, Bellón JM, Calvo B (2014) Short- and long-term biomechanical and morphological study of new suture types in abdominal wall closure. J Mech Behav Biomed Mater 37:1–11

    Article  PubMed  Google Scholar 

  17. Iavazzo C, Mamais I, Gkegkes ID (2014) The role of knotless barbed suture in gynecologic surgery: systematic review and meta-analysis. Surg Innov. doi:10.1177/1553350614554235

    PubMed  Google Scholar 

  18. Nguyen DH, Nguyen MT, Askenasy EP, Kao LS, Liang MK (2014) Primary fascial closure with laparoscopic ventral hernia repair: systematic review. World J Surg 38:3097–3104

    Article  PubMed  Google Scholar 

  19. Moreno-Egea A, Carrillo-Alcaraz A, Aguayo-Albasini JL (2012) Is the outcome of laparoscopic incisional hernia repair affected by defect size? A prospective study. Am J Surg 203:87–94

    Article  PubMed  Google Scholar 

  20. Beldi G, Wagner M, Bruegger LE, Kurmann A, Candinas D (2011) Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc 25:749–755

    Article  PubMed  Google Scholar 

  21. Carter SA, Hicks SC, Brahmbhatt R, Liang MK (2014) Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes. Am Surg 80:138–148

    PubMed  Google Scholar 

Download references

Disclosures

Drs. David Nguyen, Samuel Szomstein, Alex Ordonez, Fernando Dip, Meenakshi Rajan, Emanuele Lo Menzo, and Raul Rosenthal have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of General Surgery, Section of Minimally Invasive Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    David Nguyen, Samuel Szomstein, Alex Ordonez, Fernando Dip, Meenakshi Rajan, Emanuele Lo Menzo & Raul J. Rosenthal

Authors
  1. David Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samuel Szomstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alex Ordonez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fernando Dip
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Meenakshi Rajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emanuele Lo Menzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Raul J. Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raul J. Rosenthal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, D., Szomstein, S., Ordonez, A. et al. Unidirectional barbed sutures as a novel technique for laparoscopic ventral hernia repair. Surg Endosc 30, 764–769 (2016). https://doi.org/10.1007/s00464-015-4275-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4275-x

Keywords

Search

Navigation