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

Abstract

ObjectiveTo compare the ultrasonographic features of uterine scars and clinical symptoms after cesarean delivery (CD) using barbed and conventional smooth sutures.MethodsThis case–control study enrolled women who underwent primary CD at 37 weeks of pregnancy or later. The uterus was closed using either double‐layer unidirectional barbed suture or conventional double‐layer smooth suture. Ultrasound scans of the uterine scar and evaluations of menstrual patterns were performed at 6, 12, and 24 months after surgery.ResultsIn all, 102 patients underwent uterine closure with barbed suture, while 135 patients underwent smooth suture. At 6 months, patients in the barbed group had a lower incidence of uterine niches (20.2% vs 32.6%) that were also shallower in depth (P < 0.001). Lower incidence of niches was also observed in the barbed group at 12 and 24 months (P = 0.043 and 0.048, respectively). At these two follow‐up times, the smooth group had a higher number of patients reporting postmenstrual spotting (P < 0.05) and more postmenstrual spotting days per month (P < 0.050).ConclusionThe use of double‐layer barbed suture during CD was associated with a lower incidence of scar niches and a more favorable menstrual pattern compared with the use of smooth suture.

The presentation and management of cesarean scar defects: an updated review on an evolving diagnosis

“…Concerning suture type, meta-analysis of three RCTs comparing multifilament to monofilament suture demonstrated a significantly thicker RMT with monofilament suture [58 ▪ ]. Finally, using barbed sutures may reduce the prevalence of CSD compared with monofilament [59 ▪ ].…”

The Use of Barbed Sutures in Total Hip Arthroplasty: A Systematic Review on Clinical–Surgical Outcomes, Costs, and Complications

“…Theoretically, closure with barbed sutures should guarantee water-tight wounds and provide some advantages over traditional sutures, such as reduced closure time, wound infections, hematoma, dehiscence, and total healthcare costs [ 10 , 11 , 12 , 13 ]. The use of barbed sutures has already been extensively investigated in gynaecologic, urologic, laparoscopic, and plastic surgery [ 14 , 15 , 16 ]. In the field of orthopaedic surgery, this technology has been assessed for flexor tendon repair, where it was demonstrated to achieve similar or even greater strength when compared to traditional techniques [ 17 , 18 ].…”