Open AccessBarbed vs conventional suture at cesarean delivery: A systematic review and meta‐analysis
Author(s) -
Agarwal Sugandha,
D’Souza Rohan,
Ryu Michelle,
Maxwell Cynthia
Publication year - 2021
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.14080
Subject(s) - medicine , barbed suture , meta analysis , fibrous joint , randomized controlled trial , surgery , subgroup analysis , cochrane library , medline , relative risk , closure (psychology) , confidence interval , political science , law , economics , market economy
Barbed sutures are used in cesarean delivery with the intended benefits of better tissue approximation, hemostasis, and strength, as well as reduced operative time. A systematic review and meta‐analysis was undertaken to assess the safety and efficacy of the use of barbed suture compared with conventional sutures in cesarean delivery. Material and methods MEDLINE, EMBASE, PubMed, Scopus, Cochrane CENTRAL, and three clinical trial registries, were searched from inception to December 2019, without restriction by language or publication year. Randomized controlled trials comparing the use of barbed suture with conventional sutures in closure of any layer (uterine/fascial/skin) during cesarean delivery were included. The safety outcomes included estimated blood loss, pain, mortality, and other morbidity including infection, re‐operation or re‐admission. Effectiveness outcomes included closure time, need for additional suture and scar integrity. Study selection, data extraction, risk‐of‐bias, and quality assessment were independently performed by two authors. Primary analysis compared outcomes for all layers of surgical closure, whereas subgroup analysis was performed by individual layer. Pooled mean differences (MD) and risk ratios (RR) with 95% CI were calculated using a random effects model. Level of evidence was assessed using GRADE criteria. PROSPERO registration number: CRD42020168859. Results The review included four trials (three comparing uterine closure and one comparing skin closure), at high risk of bias, representing 460 participants. Primary analysis showed no morbidity differences between two groups. The use of barbed suture for uterine closure was associated with shorter incision closure time (MD 110.58 seconds, 95% CI 93.79‐127.36 seconds), shorter total surgical time (MD 1.92 minutes, 95% CI 0.03‐3.80 minutes), and a reduced need for additional hemostatic sutures (RR 0.39, 95% CI 0.28‐0.54), with no difference in estimated blood loss (MD 46.17 mL, 95% CI 13.55 to −105.89 mL) or postoperative morbidity (RR 0.96, 95% CI 0.46‐2.01). The level of evidence was deemed to be low to very low, based on inconsistency and imprecision of results. Conclusions Barbed sutures may be a suitable alternative to conventional sutures for uterine closure because they reduce uterine repair time, total surgical time, and the need for additional hemostatic sutures, without an increase in blood loss or maternal morbidity.