Barbed sutures in ventral hernia repair: A propensity-matched analysis of the Abdominal Core Health Quality Collaborative database

Introduction

Barbed sutures in ventral hernia repair have been used increasingly. The impact that barbed sutures has on operative time in other procedures is well documented but few reports on ventral hernia repair exist. Furthermore, the use of barbed sutures varies across surgical approaches. The aim of this study was to explore the operative time for ventral hernia repair elucidated by open, laparoscopic, or robotic approach.

Methods

Patients who underwent ventral hernia repair with fascial closure from 2020 to 2022 from the Abdominal Core Health Quality Collaborative were included. Propensity score matching 1:1 with covariates of age, American Society of Anesthesiologists class, recurrent, wound status, incisional procedure, hernia width, mesh used and type, mesh location, body mass index capped at 15 to 60, and concomitant procedures was performed by operative approach. The primary outcome of interest was operative time, and secondary outcomes were length of stay, surgical site infections, surgical site occurrences, surgical site occurrences requiring procedural intervention at 30-day follow-up.

Results

A total of 2,230 patients were included in propensity score matchings: open ventral hernia repair (n = 1,434), laparoscopic ventral hernia repair (n = 252), and robotic ventral hernia repair (n = 544). Operative time was more frequently >2 hours in robotic ventral hernia repair using nonbarbed sutures (58% vs 47%; P = .006) and was similar for open (60% vs 57%; P = .2) or laparoscopic (15% vs 21%; P = .2) approach. Across all operative modalities, using barbed sutures was strongly associated with fixation of mesh with sutures, closure of fascia in a running fashion, and more versatility in mesh locations, specifically in laparoscopic ventral hernia repair. Open ventral hernia repair had a shorter length of stay in patients with barbed sutures (2 vs 3; P = .003); however, a reoperation was more common in this same group (3% vs 1%; P = .03), specifically for recurrence (1% vs 0%; P = .04). All the other 30-day outcomes were similar across surgical approaches.

Conclusion(s)

The usage of barbed sutures was associated with shorter operative time for robotic procedures and appears to influence the overall technique used in ventral hernia repair. Higher complexity laparoscopic ventral hernia repair performed with barbed sutures had a similar operative time to simpler ventral hernia repair performed with nonbarbed sutures. Open ventral hernia repair with barbed sutures might experience an increase in early recurrences. Further studies are needed.