Barbed Double-Needle Suture for Cesarean Section Uterine Incision Closure: Postoperative Pain and 12-Month Scar Outcomes.

Abstract

Background: The optimal suture technique for uterine incision closure during cesarean section remains debated due to concerns regarding long-term scar healing. This study aimed to compare postoperative pain and scar outcomes between barbed double-needle sutures (BDNS) and traditional sutures (TS).

Methods: This retrospective cohort study included women undergoing elective term cesarean delivery from September 2022 to September 2024, grouped by uterine closure suture type. Assessed parameters included uterine closure time, blood loss, postoperative visual analog scale pain scores, analgesic use, time to first flatus and ambulation, hospital stay, 12-month sonographic residual myometrial thickness and niche incidence, and long‑term pelvic symptoms.

Results: Overall, 236 patients were analyzed (TS group, 124; BDNS group, 112). BDNS group demonstrated significantly shorter uterine closure time (3.85±0.72 vs 4.76±1.34 min, P<0.001) and reduced blood loss (285.52±54.18 vs 302.45±68.32 mL, P=0.035). Postoperative resting and activity pain scores were lower (P<0.05), with decreased analgesic requirements (P=0.024). At 12-months, residual myometrial thickness was greater (6.25±1.28 vs 5.82±1.15 mm, P=0.008), niche incidence lower (10.71% vs 24.19%, P=0.007). At 12-months postoperatively, the BDNS group showed significant improvements in SF‑36 bodily pain (P<0.001) and physical function (P=0.014) scores, while chronic pelvic pain and deep dyspareunia (P>0.05) rates did not differ significantly between groups.

Conclusion: Barbed double-needle suture closure for cesarean section is associated with improved intraoperative efficiency, reduced postoperative pain, and better uterine scar morphology compared with traditional smooth suture closure.