Barbed sutures: a manufacturer’s indications for use, and a study of use in anastamotic closures

One discussion this week involved the appropriate use of V-LOC sutures.

References: Davis J. Global Value Dossier for V-LOC Wound Closure Device: Technology and Surgical Applications (version 2.0). 2018 Apr 20. Germany: Coreva-Scientific

Tsukata T, et al. Use of barbed sutures in laparoscopic gastrointestinal single-layer sutures. JSLS. 2016 Jul-Sep;20(3): pii: e2016.00023. doi: 10.4293/JSLS.2016.00023.

Summary: When contemplating the best use for a technology, it helps to ask the creator, or in this case, the manufacturer. In section 2.4 (p.12) of their Global Value Dossier for V-LOC Wound Closure Device, Medtronic describes the indications for use as follows:

“Always refer to the package insert for indications and instructions for use of V-LocTM wound closure devices appropriate for your jurisdiction. Absorbable (V-LocTM 90 and 180), and nonabsorbable (V-LocTM PBT), devices are indicated for use in soft tissue approximation wherever the use of standard, non-barbed absorbable or non-absorbable sutures is appropriate, respectively. The product is contraindicated for patients with allergies to its components and should not be secured by tying surgical knots, or used with interrupted suturing patterns, or for ligating vessels or luminal structures. The technology has not been established for use in fascial closures (abdominal wall, thoracic, extremity fascial closures), gastrointestinal anastomoses, cardiovascular anastomoses, neurological, ophthalmic, orthopedic or microsurgery applications.”

(Davis, 2018).

In a 2016 study out of Japan, Tsukada, Kaji, Kinoshita, and Shimizu analyzed the results of 40 laparoscopic anastomoses that involved V-LOC sutures.

METHODS: Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection.

RESULTS: 38 patients underwent 40 laparoscopic anastomoses

( 26 esophagojejunostomies; 7 gastrojejunostomies; 7 simple closure of gastric defect)

  • No cases required conversion to open surgery.
  • Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect)
  • Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use.
  • No postoperative complications at the anastomosis site and no surgery-related deaths were noted.

CONCLUSION: Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases.

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