Barbed Sutures in Thoracoscopic Eventration Repair

Abstract

Introduction:

Diaphragmatic eventration is an abnormal ballooning of the diaphragm cephalad causing physiologic embarrassment. ¹ Plication of the diaphragm is a tried and true method of increasing intrathoracic volume, thus allowing for better lung expansion and growth. ² Many methods have been described since the introduction of thoracoscopic plication of the diaphragm, signaling two things: (1) the difficulty of the task and (2) lack of one clearly superior method. Barbed sutures offer a method of true plication without the difficulty of intracorporial tying under tension. In addition, this method could decrease the time and complexity of the operation during which the patient is being ventilated on one lung, helping to limit barotrauma in preemies. The video demonstrates the use of barbed sutures to plicate a right diaphragmatic eventration.

Materials and Methods:

The patient was a former 31-week postmenstrual age male baby. He was 6 weeks old and weighed 2.2 kg at the time of the procedure. His respiration rate was 80 breaths per minute and was managed on 3 L of high-flow oxygen through nasal cannula with an inability to wean. Preoperative radiographs showed a significant eventration of the right hemidiaphragm. A 3–0 permanent barbed suture gave the surgeon the ability to continually plicate without having to tie numerous knots or tying the entire row of plicated diaphragm in one difficult intracorporeal knot under tension. As this was the first application of barbed sutures on a preemie diaphragm, we elected to place Ethibond sutures tied intracorporially overtop the barbed sutures to ensure equivalency of repair. Two barbed suture rows were placed and several interrupted Ethibond sutures were placed.

Results and Conclusions:

The flattening of the diaphragm was satisfactory and no chest tube was left in the patient. Postoperative chest radiographs showed a significant improvement in the volume available to the right lung. A 2-month postoperative radiograph continues to show this improvement. The use of barbed sutures made intracorporeal suturing safer, simpler, and aided the placement of the traditionally definitive permanent woven sutures. As long-term data on the durability of barbed sutures emerge, we foresee barbed sutures obviating the need for the traditional intracorporeally tied sutures.

No competing financial interests exist.

Runtime of video: 4 mins 57 secs

Presented at the International Pediatric Endosurgery Group's 26th Annual Congress in London, England, July 19–22, 2017.