Barbed Sutures at the Hiatus: What's the Evidence?

IF 1.3 4区医学 Q3 SURGERY

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Pub Date : 2026-04-01 DOI:10.1097/SLE.0000000000001436

Benjamin Clapp, Priya Patel, Jorge Urbina

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引用次数: 0

Abstract

Background: Barbed sutures enable knotless, continuous cruroplasty and are increasingly used in hiatal and paraesophageal hernia repairs. Despite widespread adoption, outcome data specific to the hiatus are limited and diaphragmatic application remains off-label.

Methods: A systematic search of PubMed and MEDLINE (inception-August 2025) identified adult hiatal/paraesophageal hernia repairs using barbed sutures. Data on operative approach, mesh use, operative time, recurrence, and perioperative outcomes were extracted. The FDA MAUDE database (2010 to 2025) was reviewed for device-related events.

Results: Five studies (n=741) met the inclusion criteria. In laparoscopic comparisons, barbed sutures shortened per-stitch closure time compared with interrupted silk, although total closure time was not significantly different. In pooled analysis of 4 comparative studies, the weighted mean difference in operative time was +12.8 minutes (95% CI: -4.3 to 29.8; P =0.14; I ²=40%). Individual series demonstrated variable findings: operative time increased with mesh reinforcement but not when mesh was avoided ( P =0.45). One study reported that barbed cruroplasty with biosynthetic mesh reinforcement significantly reduced ≥1-year anatomic recurrence (24.7% vs. 44.9%; risk difference -20.3%, 95% CI: -33.7 to -7.0) and symptomatic recurrence (17.2% vs. 42.2%, P =0.003) compared with barbed suture-only repair. Postmarket surveillance analysis of the FDA MAUDE database (2010 to 2025) identified only 2 hiatal-specific adverse events associated with barbed sutures, although underreporting is likely.

Conclusions: Barbed sutures for cruroplasty appear time-efficient and may lower recurrence when combined with mesh in larger hernias. However, current evidence is sparse, heterogeneous, and based largely on retrospective series. Given the off-label nature of diaphragmatic use, prospective studies with standardized recurrence definitions are needed to clarify safety and long-term efficacy.

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裂口处的倒钩缝合线：证据是什么？

背景：倒钩缝线可以实现无结、连续的疝成形术，越来越多地用于食管裂孔和食管旁疝的修复。尽管被广泛采用，但针对间隙的具体结果数据有限，并且膈肌应用仍未得到认可。方法：系统检索PubMed和MEDLINE（盗- 2025年8月），确定成人食道裂孔/食道旁疝采用倒钩缝合修复。提取手术入路、补片使用、手术时间、复发和围手术期结果的数据。FDA MAUDE数据库（2010年至2025年）审查了与器械相关的事件。结果：5项研究（n=741）符合纳入标准。在腹腔镜比较中，倒钩缝合与断丝缝合相比缩短了每针缝合时间，尽管总缝合时间没有显著差异。在4项比较研究的合并分析中，加权平均手术时间差为+12.8分钟（95% CI: -4.3 ~ 29.8； P=0.14; I²=40%）。个别系列显示了不同的结果：补片加固后手术时间增加，而避免补片时没有增加（P=0.45）。一项研究报道，与仅用倒钩缝合修复相比，生物合成补片加固的倒钩肾成形术可显著降低≥1年的解剖复发率（24.7% vs. 44.9%；风险差异-20.3%,95% CI: -33.7 ~ -7.0）和症状复发（17.2% vs. 42.2%， P=0.003）。FDA MAUDE数据库的上市后监测分析（2010年至2025年）仅确定了2例与倒刺缝合线相关的局部特异性不良事件，尽管可能存在漏报的情况。结论：在大疝修补术中，与补片联合使用倒钩缝合更省时，可降低复发率。然而，目前的证据是稀疏的，异质性的，并且主要基于回顾性的系列。考虑到横膈膜手术的标签外性质，需要有标准化复发定义的前瞻性研究来阐明安全性和长期疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 医学-外科

CiteScore

2.00

自引率

10.00%

发文量

103

审稿时长

3-8 weeks

期刊介绍： Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.