Safety and efficacy of knotless barbed suture in cesarean section using postpartum ultrasound: a retrospective cohort study

Background: While speed, safety, and efficacy are necessary in the operation of cesarean section (CS), a number of new devices have been introduced to support the technique. This retrospective study was conducted to assess the usability and safety of knotless barbed suture, compared to conventional method, for closure of uterine myometrium during cesarean section. Methods: Patients who underwent cesarean delivery at Korea University Ansan Hospital between August 2018 and December 2019 were reviewed. Surgical outcomes including uterine closure time, operating time, estimated blood loss, and sonographic results of residual myometrial thickness at the site of incision at 6 to 8 weeks after operation were analyzed. Results: Out of total 78 women, 44 patients had knotless barbed suture and 34 patients underwent conventional suture. Compared to conventional method, the uterine closure time was significantly reduced (p = 0.012). Operative time, estimated blood loss during operation, hemoglobin difference on the third operative day, and the number of cases with transfusion, postpartum infection, and bleeding demonstrated no significant differences between the two groups. At 6 to 8 weeks after operation, transvaginal ultrasound revealed no differences in residual myometrial scar thickness. Conclusion: Knotless barbed suture resulted in significantly shorter uterine closure time and no increased rate of perioperative complications. Our work supports that knotless barbed suture can be effectively used for cesarean section.