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Related Concept Videos

Sutures of the Skull01:22

Sutures of the Skull

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The human skull is composed of several bones that come together to protect the brain and support the structures of the face. The junctions where these bones meet are called sutures.
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
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Related Experiment Video

Updated: Jan 14, 2026

Author Spotlight: Development and Evaluation of a Standardized Rat Model for Calvarial Suture-Bony Composite Defects
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Author Spotlight: Development and Evaluation of a Standardized Rat Model for Calvarial Suture-Bony Composite Defects

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Barbed Sutures at the Hiatus: What's the Evidence?

Benjamin Clapp1, Priya Patel2, Jorge Urbina3

  • 1El Paso Bariatric Surgery, El Paso, TX.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
|January 13, 2026
PubMed
Summary

Barbed sutures may be time-efficient for hiatal hernia repair and can reduce recurrence when used with mesh. However, more research is needed to confirm their safety and effectiveness, especially since their use on the diaphragm is off-label.

Keywords:
barbed sutureshiatal herniahiatal hernia repair

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Area of Science:

  • Minimally Invasive Surgery
  • Gastrointestinal Surgery
  • Surgical Innovation

Background:

  • Barbed sutures are increasingly utilized for knotless cruroplasty in hiatal and paraesophageal hernia repairs.
  • Despite widespread adoption, specific outcome data for diaphragmatic application are limited, and its use remains off-label.

Purpose of the Study:

  • To systematically review the current literature on the use of barbed sutures in adult hiatal and paraesophageal hernia repairs.
  • To evaluate operative outcomes, recurrence rates, and device-related adverse events associated with barbed suture cruroplasty.

Main Methods:

  • A systematic literature search of PubMed and MEDLINE (inception–August 2025) was conducted.
  • Data extraction included operative approach, mesh use, operative time, recurrence, and perioperative outcomes.
  • The FDA MAUDE database (2010–2025) was reviewed for device-related events.

Main Results:

  • Five studies (n=741) met inclusion criteria. Barbed sutures shortened per-stitch closure time but not total closure time compared to silk.
  • Pooled analysis showed no significant difference in total operative time (P=0.14).
  • Barbed cruroplasty with mesh reinforcement significantly reduced recurrence rates (anatomic and symptomatic) compared to barbed suture-only repair. Only two hiatal-specific adverse events were identified in the FDA MAUDE database.

Conclusions:

  • Barbed sutures appear time-efficient for cruroplasty and may reduce recurrence when combined with mesh in larger hernias.
  • Current evidence is limited, heterogeneous, and primarily from retrospective series.
  • Prospective studies with standardized recurrence definitions are necessary to establish the safety and long-term efficacy of off-label diaphragmatic use.