We included patients who underwent VATS pulmonary resection at Samsung Medical Center (SMC) from October 1 to October 31, 2016. Patients who underwent esophageal resection, mediastinal resection, or open pulmonary resection were excluded from this study. A total of 111 patients underwent VATS pulmonary resection at SMC during this period. Among the 111 patients, 1 patient was excluded from the analysis of postoperative complications due to death in the early postoperative period and another patient was also excluded due to prolonged hospitalization for other complications. Eight-five patients underwent VATS pulmonary resection with chest drain wound closure utilizing knotless suture material (Stratafix [Ethicon, Somerville, NJ, USA] or V-loc [Covidien, Minneapolis, MN, USA]) and 24 patients underwent VATS pulmonary resection with chest drain wound closure by the conventional method. We assumed that the surgical procedure would not influence the outcome of chest tube wound-related complications. Lung cancer was the primary disease for which pulmonary resection was performed, in addition to a few cases for benign lung diseases such as non-tuberculous mycobacteria (NTM). The chest drain wound closure method was chosen based on the surgeon’s personal preference.
Stratafix
Manufactured by Johnson & Johnson
Sourced in United States
Stratafix is a synthetic absorbable surgical suture designed for soft tissue approximation and/or ligation, including use in ophthalmic procedures. It is composed of a copolymer of glycolide and e-caprolactone and is available in a variety of sizes and needle configurations.
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Lab products found in correlation
7 protocols using stratafix
1
VATS Pulmonary Resection: Chest Drain Closure Techniques
2
Comparative Analysis of Suture Closure Techniques
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The primary independent variable of interest was closure suture type in the fascial layer, dichotomized into interrupted suture and barbed suture closure. The standard interrupted technique was done using #1 Vicryl sutures in the fascia in a figure of eight fashion, followed by 2-0 Vicryl sutures in the deep dermal layer and 2-0 nylon sutures for skin. The barbed suture closure technique was done with #1 Stratafix™ (EthiconⓇ) barbed suture in the facia in a running fashion, followed by 2-0 Vicryl suture in the deep dermal layer and 2-0 nylon sutures for the skin. At our institution, the average cost for Stratafix suture is $23.23 per pack, while the average cost for #1 Vicryl is $9.63. Typically, one pack of Stratafix suture is sufficient in closure, compared to two packs of #1 Vicryl. Therefore, the cost of the two closure methods is comparable. Selection criteria for traditional interrupted and barbed suture closure were based on an institution-wide adoption of barbed suture rather than surgeon preference and consistent within and among surgeons.
3
Standardized Fascial Closure Techniques
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Surgical procedures are performed under general anesthesia and by an experienced surgeon. To achieve standardization of suture technique, we provide surgeons with formal video of fascial closure using two suture materials. The location of the midline incision, which is supra-, trans-, or infra-umbilical mini-laparotomy, is determined according to the surgeon’s preference. At the end of surgery, fascia closure is achieved with absorbable barbed sutures (Stratafix®, Ethicon Inc., USA) for the study group and absorbable monofilament sutures (Maxon®, Covidien Inc., USA) for the control group. In all cases, the suture-to-wound length ratio is at least 4:1 for closure of the midline incision, and the inter-suture spacing is less than 1 cm. We avoid mass closure, which is performed with a suture bite, including all layers of the abdominal wall, except the skin. A single aponeurotic closure is applied to the midline incision in both groups. Subcutaneous tissue closure is not mandatory in this study. The skin can be approximated by using staples.
4
Suturing Peritoneal Flaps Using Barbed Sutures
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The intraperitoneal pressure was decreased to 8 mmHg to reduce tension during suturing. We started suturing from medial to lateral using 3‐0 Stratafix (1/2 circle needle; Ethicon, Raritan, NJ), and closed the opened peritoneum with barbed sutures. To adjust the alignment of the anterior and posterior flaps, we sutured halfway around for both flaps.
5
Abdominoplasty with Liposuction and Dressing Comparison
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A standard abdominoplasty procedure was undertaken in all patient utilizing liposuction on the flanks and not the abdominoplasty flap. Two standard 15FR suction drains were inserted before closure sited laterally on each side. Standard layered closure of the Scarpa’s and skin layers was done using 3-0 and 4-0 resorbable monofilament sutures (MONOCRYL and STRATAFIX, Ethicon).
Seven consecutive patients were dressed with skin adhesive and tapes (Prineo), whereas the remaining 9 consecutive patients were dressed with the iNPWT Prevena System encompassing the whole incision (Fig.1 ). This dressing delivered the negative pressure at 125 mm Hg and was kept in place for 7 days and removed thereafter.
An abdominal binder was applied over the dressings to all patients and maintained for 6 weeks. Drains were removed if the total output was less than 50 ml/day. All patients were discharged from the hospital on postoperative day 7 and were followed up at 2 weeks, 4 weeks, and 6 months post operatively.
Seven consecutive patients were dressed with skin adhesive and tapes (Prineo), whereas the remaining 9 consecutive patients were dressed with the iNPWT Prevena System encompassing the whole incision (Fig.
An abdominal binder was applied over the dressings to all patients and maintained for 6 weeks. Drains were removed if the total output was less than 50 ml/day. All patients were discharged from the hospital on postoperative day 7 and were followed up at 2 weeks, 4 weeks, and 6 months post operatively.
6
Surgical Approach for Bariatric Patients
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The surgical approach was described in our previous article (18 (link)).
All patients were screened preoperatively by a multidisciplinary bariatric team, and written informed consent was obtained. Esophagogastroduodenoscopy, assessment for sleep apnea, and gallstones using ultrasonography were performed. Patients with gallstones underwent a concomitant cholecystectomy.
Of interest, our anastomotic technique changed over time, going from linear stapling to totally hand-sewn anastomosis. This change reflects a modification in the surgical habits over the period of the study. In the mechanical anastomotic technique, an antegastric end-to-side 3-cm gastrojejunostomy (GJ) anastomosis was created with a 45-mm linear stapler and the stapler opening was closed by means of a STRATAFIX™ (Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA) running suture. In the hand-sewn anastomotic technique, an end-to-side GJ anastomosis of 2 cm in diameter was created with two STRATAFIX ™ full-thickness running sutures.
All patients received subcutaneous thromboprophylaxis with low-molecular-weight-heparin (LMWH) the day before and 6 h after surgery, according to their body weight and until 30 days after discharge. We allowed free liquid intake on postoperative day 0 and introduced a pureed diet on postoperative day 1. After adequate liquid intake and pain control, patients were discharged home.
All patients were screened preoperatively by a multidisciplinary bariatric team, and written informed consent was obtained. Esophagogastroduodenoscopy, assessment for sleep apnea, and gallstones using ultrasonography were performed. Patients with gallstones underwent a concomitant cholecystectomy.
Of interest, our anastomotic technique changed over time, going from linear stapling to totally hand-sewn anastomosis. This change reflects a modification in the surgical habits over the period of the study. In the mechanical anastomotic technique, an antegastric end-to-side 3-cm gastrojejunostomy (GJ) anastomosis was created with a 45-mm linear stapler and the stapler opening was closed by means of a STRATAFIX™ (Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA) running suture. In the hand-sewn anastomotic technique, an end-to-side GJ anastomosis of 2 cm in diameter was created with two STRATAFIX ™ full-thickness running sutures.
All patients received subcutaneous thromboprophylaxis with low-molecular-weight-heparin (LMWH) the day before and 6 h after surgery, according to their body weight and until 30 days after discharge. We allowed free liquid intake on postoperative day 0 and introduced a pureed diet on postoperative day 1. After adequate liquid intake and pain control, patients were discharged home.
7
Knotless Chest Tube Suture Technique
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As each operation was completed, the chest drain was inserted and an anchoring suture was placed with either silk or nylon. After the muscle layer was sutured, the subcutaneous layer was sutured using unidirectional absorbable sutures, either Stratafix (Ethicon, Somerville, NJ, USA) or V-loc (Covidien, Minneapolis, MN, USA). Closure of the chest drain began at the end of an incision; instead of tying the knots, the tip of the needle entered through the fixation loop and was tightened. The needle was then placed horizontally through the subcutaneous layer by passing through the opposite sides of the wound in exactly the same way as is done in the continuous subcutaneous suture technique. The suture continued around the chest tube until the needle reached the other end of the incision. The tip of the needle passed under the skin and came out through the skin about 1 cm from the edge of the incision. The needle was then cut off and the rest of the thread was secured to the skin with an adhesive [2 (link)]. When the chest tube was being removed, the anchoring suture was cut off, and then the chest tube was withdrawn while the adjacent tissue was held tightly to prevent pneumothorax. The secured thread was then pulled forward to tighten the suture. Fig. 1 illustrates the knotless suture method [2 (link)].
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