32: Knotless barbed suture closure of the uterine incision at cesarean - a randomized controlled trial

Abstract

Knotless barbed sutures are becoming increasingly available for surgical procedures in obstetrics and gynecology. Our purpose was to determine if the use of the knotless barbed suture reduces closure time of the uterine incision at cesarean delivery. This was a prospective randomized controlled trial. The primary outcome was closure time of the uterine incision. In order to show a decrease of 25% from 6 min to 4.5 min using the knotless barbed suture with a power of 0.9 and type 1 error of 5%, at least 34 women would be needed in each group. Women were randomized by sealed envelope to uterine closure with either a bidirectional knotless barbed suture or polyglactin 910 braided (conventional) suture. Secondary outcomes included blood loss during incision closure and the number of additional hemostatic sutures needed. Patients were enrolled from August 2016 until March 2017. 102 women were randomized. Fifty-one had uterine closure with knotless barbed suture and 51 with conventional suture. The groups were similar for demographics as well as number of previous cesareans. Uterine closure time using the knotless barbed suture was significantly shorter than the conventional suture by a mean of 1 min 43 sec (P<0.000, 95% CI 67.69 - 138.47 sec). Blood loss estimated during incision closure was significantly lower (mean 221 ml versus 268 ml, P<0.005) and the use of hemostatic sutures was significantly less (median 0 versus 1, P<0.0001). The use of a knotless barbed suture significantly reduced closure time of the uterine incision. There was also less need for additional hemostatic sutures and slightly reduced estimated blood loss.