Barbed continuous suture reduces the risk of specimen extraction site hernia in high-risk obese patients: a CT-based...

Extraction-site hernia (ESH) is a recognized complication after laparoscopic colorectal surgery. Obesity increases the risk of ESH, may make fascial closure more difficult, and has been identified as a risk factor. We investigated whether barbed continuous suturing reduces the incidence of ESH compared with interrupted suturing, particularly in obese patients.

We retrospectively analyzed 193 patients who underwent laparoscopic colorectal surgery at a single center. Closure technique transitioned from interrupted sutures (n = 93) to barbed continuous sutures (n = 100). Propensity score matching using 11 covariates yielded 79 matched pairs. ESH was assessed by computed tomography at 12 months and at the end of follow-up.

In the matched cohort, the 12-month incidence of ESH was significantly lower in the barbed continuous group than in the interrupted group (10.1 vs. 32.9%; P = 0.0008). Over the full follow-up period, the overall incidence was 15.2 vs. 38.0% (P = 0.0020). Multivariable analysis identified barbed continuous suturing as an independent protective factor (aOR 0.16; 95% CI 0.06-0.41; P = 0.0003), whereas higher BMI remained an independent risk factor (aOR 1.16 per 1 kg/m²; 95% CI 1.01-1.33; P = 0.034). In obese patients (BMI ≥ 25 kg/m²), the 12-month incidence of ESH was 48.0% in the interrupted group and 10.5% in the barbed continuous group, corresponding to an absolute risk reduction of 37.5% and a number needed to treat of 2.7. Restricted mean survival time analysis showed a 7.3-month longer hernia-free period in the barbed continuous group (36.6 vs. 29.2 months; 95% CI for the difference, 3.2-11.4; P < 0.001).

Barbed continuous suturing was associated with a lower incidence of ESH after laparoscopic colorectal surgery, particularly in obese patients. Prospective multicenter studies are needed to confirm these findings and define the significance of hernia repair.