The Effect of Barbed Sutures on Complication Rates Post Colectomy: A Retrospective Case-Matched Review

Background and objective Colectomies are common general surgical procedures performed for a variety of gastrointestinal disorders ranging from benign to malignant. Early definitive fascial closure has been shown to improve outcomes in patients following abdominal surgery. Conventional loop sutures and their accompanying knots present several disadvantages and require technical expertise. Reducing complications has been a strong driver for innovations such as the use of barbed sutures. Barbed sutures consist of axially spaced barbed segments on each side of a midpoint at which the barbs change directions. This study is a retrospective case-matched review that evaluates the effects of barbed sutures compared to non-barbed sutures on the rates and severity of postoperative complications following colectomies for abdominal fascial closure. Materials and methods The study enrolled 151 patients who underwent open and minimally invasive colorectal abdominal surgeries from January 1, 2017, to November 30, 2019. Primary outcome measures included operative time, length of hospital stay, and postoperative complications compared between barbed and non-barded suture types. The sub-analysis further compared the surgical approach (open vs. robotic/laparoscopic) and incision type (Pfannenstiel vs. midline and other) between the suture types. Results The mean operative time for barbed sutures was 177 minutes, while it was 157 minutes for non-barbed sutures, resulting in a significant difference (p=0.0264). No significant difference was noted in postoperative complications between the groups. Conclusions The results of this study indicate that the use of barbed sutures in colorectal surgery does not increase the chances of postoperative infections, prolonged hospital stays, or other postoperative complications. Barbed sutures resulted in fewer class IV complications and more class I complications when compared to non-barbed sutures. Barbed sutures have proven to be beneficial in cases that require good wound approximation in high-tension areas and they eliminate the need for knots.