Comparison of two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs

Abstract

Background: Hand-sewn intestinal anastomoses are a fundamental procedure in both open and laparoscopic intestinal surgery. Self-retaining barbed suture devices have been tested for a variety of surgical applications. With the exception of clinical reports and various experimental studies on enterotomy, little has been published so far on the use of barbed suture for end-to-end intestinal anastomoses. The aim of the study was to compare two different barbed suture materials for end-to-end jejuno-jejunal anastomosis in pigs. End-to-end jejuno-jejunal anastomosis were performed with unidirectional barbed (A group), bidirectional barbed (B group) or normal (C group) sutures in each animal. A comparison was then made between the groups based on adhesions scoring, suturing time, bursting pressure and histopathology.

Results: Mean construction times in the A group (518 ± 40 s) and in the B group (487 ± 45 s) were significantly lower than in the C group (587 ± 63 s) but were not different between A and B group (P = 0.10). Mean bursting pressures were significantly higher in the intact intestine (197 ± 13 mmHg) than in any other group (group A 150 ± 16 mmHg, group B 145 ± 22 mmHg, group C 145 ± 24 mmHg). Among anastomotic techniques, the bursting pressures were not significantly different. Histologically no difference could be detected in the grade of inflammation, collagen deposition and neovascularization at the anastomotic sites.

Conclusions: Barbed sutures can be effectively used for handsewn end-to-end jejunojejunal anastomosis in pigs. They are comparable to normal suture but could provide a shorter surgical time.

Keywords: Barbed suture; End-to-end anastomosis; Jejunojejunal; Pigs.

Fig. 1

Diagram demonstrating step by step procedure for the continuous modified extramucosal pattern used in the present study

Fig. 2

Diagram demonstrating the system used for bursting pressure measurements of the anastomoses

Fig. 3

Photomicrograph of granulation tissue between submucosa and muscle layers at the anastomotic site for each group (a Byosin unbarbed suture, b unidirectional barbed suture, c bi-directional barbed suture). a Foreign material—suture surrounded by a large amount of inflammatory cells (lymphocytes and giant cells (*); b, c a large hole indicates the area of suture material, surrounded by a large number of inflammatory cells (*) and abundant fibrous tissue with a lot of collagen fibres. Hematoxylin–Eosin; Bar: 100 µm