Barbed vs conventional suture at cesarean delivery: A systematic review and meta‐analysis

Abstract

Introduction: Barbed sutures are used in cesarean delivery with the intended benefits of better tissue approximation, hemostasis, and strength, as well as reduced operative time. A systematic review and meta-analysis was undertaken to assess the safety and efficacy of the use of barbed suture compared with conventional sutures in cesarean delivery.

Comparison of the effect of skin closure materials on skin closure during cesarean delivery

“…They can reduce the wound closing time and improve the operation efficiency. Recently, Agarwal et al [ 5 ] In comparison with the use of barbed suture and absorbable sutures in cesarean delivery, it is shown that the barbed suture can replace the absorbable common suture, which can reduce the time of closure and incidence rate of wound complications. However, these studies only focused on the comparison between barbed suture and ordinary suture.…”

“…In contrast, NMA combines many published RCTs, which have a broader basis, comprehensively evaluate several types of skin closure materials, and integrate direct and indirect comparisons. And from the cost effect analysis, the cost of barbed suture is much higher than that of ordinary suture [ 5 ]. This study has clinical significance because it qualitatively compares the selection of appropriate skin closure materials to close the wound during cesarean delivery and provides a reference for obstetricians.…”

“…What sutures or suture combinations are used in any particular surgical case varies widely among surgeons [ 4 ]. The selection of skin closure materials is usually based on surgeon’s preference, institutional agreement, availability and cost of specific materials, or current interest in exploring a new technology based on technological progress [ 5 ]. Therefore, it is necessary to evaluate skin closure materials.…”

“…Previous meta-analysis shows that absorbable suture reduces the risk of skin separation compared with suture staple, but increases the time of wound suture [ 7 – 9 ]. Compared with suture, the barbed suture reduces the time to skin closure of dermal and epidermal layer and total operative time without increasing blood loss or maternal incidence rate [ 5 ]. Therefore, the purpose of this study is to update the evidence through network meta-analysis (NMA) and compare the time to skin closure, incidence of skin separation and wound complications of different skin closure materials during skin incision suture in cesarean delivery.…”

Incidence and ultrasonographic characteristics of cesarean scar niches after uterine closure by double‐layer barbed suture: A prospective comparative study

“…In the last 10 years, barbed sutures have been proposed to close the hysterotomy during CD. A systematic review with meta‐analysis showed that the use of a barbed suture during CD may lead to significant advantages in terms of reduced surgical time and need for additional hemostatic sutures, without increasing morbidity or estimated intraoperative blood loss compared with conventional smooth (monofilament/multifilament) suture 10 . Because a barbed suture provides constant tension on tissue, which improves bleeding control, 9 its use may lead to improved uterine wall healing following CD, therefore also reducing the formation of uterine scar defects (considered a surrogate endpoint for future uterine rupture and abnormal placentation) 4,5 .…”