BACKGROUND AND PURPOSE:

• Knotless barbed sutures self-anchor without the need for surgical knots
• Knotless sutures are used in laparoscopic surgeries but data for open surgeries are limited
• Peleg et al. (AJOG 2018) assessed if knotless barbed sutures could be used for uterine closure during cesarean section

METHODS:

• Prospective, randomized controlled trial
• Patients were randomized to receive double layer closure using either
  • Conventional suture
  • Knotless barbed suture
• Primary outcome: Length of time needed to close the uterine incision
  • Defined as time from start of the first suture placement until obtaining uterine hemostasis
• To eliminate provider bias, women were randomized in the operating room just prior to uterine closure
• Secondary outcomes: Number of additional hemostatic sutures needed and blood loss during incision closure

RESULTS:

• 102 women were included in the study
  • 51 women had knotless barbed sutures
  • 51 women had conventional suture
• The groups were similar in demographics as well as number of previous cesarean sections
• Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture
  • Knotless closer was faster by a mean of 1 minute 43 seconds (95% CI, 67.69–138.47 seconds; P< .001)
• Knotless barbed sutures were associated with
  • Fewer hemostatic sutures (median 0 vs 1, P< .001)
  • Lower blood loss measured during incision closure (mean 221 mL vs 268 mL, P< .005)

CONCLUSION:

• The use of knotless barbed sutures reduced operation time, and were associated with lower need for hemostatic sutures and blood loss
• The authors noted that cost of knotless suture is 7 to 20X that of conventional suture
  • However, more suture may be required for 2 layer closure plus hemostatic sutures
• Knotless sutures have delayed absorption that may have implications for recovery
• Knotless sutures correct for some problems associated with knots
  • Knotless sutures allow for uniform distribution of tension
  • Knots themselves reduce tensile strength of the suture
  • Knots have increased volume which may result in additional inflammation
  • Easier placement

Learn More – Primary Sources:

A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery

Related ObG Topics:

Does Adding a 2nd Layer to Uterine Closure of a Cesarean Section Alter Outcomes?

Do Different Surgical C-Section Techniques Affect Outcomes?

Which is the Better Suture to Prevent C-Section Wound Complications?