The use of barbed suture in bladder and bowel surgery

A new class of suturing material, barbed suture, was recently added to the surgeon's armamentarium. It was initially used in open surgery for soft tissue approximation. Its applications in laparoscopic surgery quickly flourished because it eliminates the time-consuming process of extracorporeal and intracorporeal knot tying. Data supporting the use of barbed suture for the repair of bladder and bowel injuries is still scarce. As a matter of fact, many surgeons still use conventional sutures, secured with knots, when facing a cystotomy or an enterotomy. Choosing the best suture material for a specific surgical procedure lies in a thorough understanding of the suture properties. In this article, we shed light on the characteristics that make barbed suture attractive for bladder and bowel repair and illustrate our surgical approach for cystotomy and enterotomy repair using this novel suture material. Based on our experience at Magee-Womens Hospital, barbed suture provides adequate tension-free repairs and improves the efficiency of laparoscopic suturing when closing bladder or bowel defects. As we have so far not encountered any complications, we conclude that repairing cystotomies and enterotomies with barbed suture is feasible and safe.