Role of Barbed Sutures in Repairing Uterine Wall Defects in Laparoscopic Myomectomy: A Systemic Review and Meta-Analysis

As an innovative technology barbed sutures have demonstrated clinical and surgical benefits in several specialties. The purpose of this study was to systemically review the available evidence on the application of barbed sutures in repairing the uterine wall defects in laparoscopic myomectomy and to compare with conventional suture in clinical safety and efficacy. Medline, Embase, and Cochrane Database of Systematic Reviews were used for a systematic electronic search of published literature. Studies were selected that evaluate barbed sutures in surgical treatment for patients with benign myomas eligible for laparoscopic myomectomy in comparison with conventional sutures. Depending on the heterogeneity, either a fixed-effects model or random-effects model was used in this meta-analysis. Continuous variable data were showed as standard mean difference (SMD) and weighted mean difference with 95% confidence interval (CI). A total of 7 studies (n = 484) met inclusion criteria. Compared with conventional sutures, barbed sutures demonstrated significant reductions in suturing time (SMD, -1.26; 95% CI, -1.85 to -.67; p < .001), operating time (SMD, -.64; 95% CI, -.83 to -.44; p < .001), intraoperative blood loss (SMD, -.43; 95% CI, -.79 to -.06; p = .021), and postoperative hemoglobin drop (SMD, -.56; 95% CI, -1.01 to -.11; p = .014). The result was numerically lower in the barbed suture group for hospital length of study, although there was no significant difference. This meta-analysis demonstrates clear clinical advantages of time savings and blood loss reduction by using barbed sutures in close uterine wall defects in laparoscopic myomectomy compared with conventional sutures. Those benefits may reduce the surgical difficulty in laparoscopic myomectomy procedures.