Barbed suture in total laparoscopic hysterectomy: A comparative study of the safety in vaginal cuff closure with that of polyglactin 910 suture

Abstract

Objectives: To evaluate whether the use of barbed sutures during laparoscopic hysterectomy for vaginal cuff closure has reduced the surgical difficulty and incidence of post-operative complications as compared to polyglactin 910 suture. Materials and Methods: This is a randomized comparative study conducted at a tertiary care hospital and research institute where 100 patients were divided into two groups (50 each) and underwent vault closure using barbed suture/Polyglactin 910. Data collected include demographic details, indication for surgery, mean suturing time, degree of surgeon difficulty, and the incidence of postoperative complications when followed up to 12 weeks and were compared statistically using Chi square test and Independent-t test. Results: The use of barbed suture has significantly reduced the suturing time (5.39 min vs. 6.9 min, P < 0.0001) and surgical difficulty. The incidence of minor complications is similar to that of polyglactin 910. There were no cases of vaginal cuff dehiscence or bowel obstruction reported in our study. Conclusion: With the advantages of reduced suturing time and technical difficulty, and incidence of complications similar to conventional suture material, barbed sutures are to be considered as an excellent alternative to conventional suture materials.

Prevention and management of vaginal cuff dehiscence: an updated review

“…The most common are monopolar, bipolar, and ultrasonic energy. One of the hypotheses surrounding higher rates of VCD after TLH and RATLH is the use of thermal energy for the colpotomy, which affects wound healing [4,6 ▪ ,23]. Taskin et al [23] designed a randomized control trial of 210 patients investigating the effects of monopolar coagulation vs. monopolar cut mode for the colpotomy and no significant difference in VCD rate was observed.…”

“…A large systemic review and meta-analysis found that barbed suture decreased the risk for VCD in TLH and RATLH but a sub-analysis looking only at TLH did not find a difference in VCD rate between barbed suture and traditional absorbable suture [3 ▪▪ ]. Several studies, including a systemic review and meta-analysis of 11 studies, showed that there was no significant difference in VCD rate when comparing absorbable barbed, traditional absorbable, and/or permanent suture [3 ▪▪ ,6 ▪ ,18,21 ▪ ,32–34]. With this mixed information, surgeons should use the appropriate suture they are most comfortable with.…”

“…With this mixed information, surgeons should use the appropriate suture they are most comfortable with. Although it has not been shown to be superior, barbed suture has the benefit of being self-retaining and knotless and has been shown to decrease vaginal cuff closure time [6 ▪ ,21 ▪ ,31,34]. On the downside, barbed suture is more expensive to use and may not be available in low-resource settings [21 ▪ ,32].…”

“…On the downside, barbed suture is more expensive to use and may not be available in low-resource settings [21 ▪ ,32]. Whenever choosing a suture, the surgeon should always consider options that minimize bacterial growth, cause little tissue reactivity, and maintain appropriate tension for healing [6 ▪ ,18].…”

“…In the last decade, the route of hysterectomy has dramatically changed – with an over 200% increase in the rate of laparoscopic hysterectomy [6 ▪ ,7,8,9 ▪ ,10]. Though the percentage of VCD has been shown to be higher in endoscopic approaches, recent studies have identified factors that may ameliorate VCD risks [6 ▪ ,7,8]. In this article, we aim to provide an updated literature review of VCD incidence, risk factors, prevention strategies, and management…”