A barbed suture is a suture with small helical spines along its entire surface.
These sutures have a sort of teeth or barbs along them. Once the suture line is applied, each of the teeth or barbs of the thread in this suture prevents the thread
from moving. Due to this effect, when the suture is passed through the tissue, the suture does not turn back, but remains fixed in the position in which the surgeon placed it.
Barbed sutures, having small incisions all in the same direction, create a unidirectional hook effect throughout the suture that allows passage in one direction through the tissue, but not in the opposite one.
This suture prevents the loss of suture tension and therefore an assistant can release it and optimize the surgeon’s surgical field. In addition, it can facilitate surgical practice, avoiding the need for intracorporeal knot tying. It is not easy for a surgeon, at least at first, to use a suture and not tie it without having doubts about its security. However, existing data indicate that barbed sutures have a tensile strength that is comparable to their un-barbed equivalents, as reported in several in vitro studies.
Most of these studies examine the mechanical characteristics of barbed sutures in a fairly limited number of cases. Studies are required to evaluate the long-term biological effects of this suture and compare different types of barbed suture. It is also important to study the convenience or not of using other fasteners (clips or similar) at the end of the suture.
Barbed sutures have been used in recent years in different specialties. In general surgery, the vast majority of publications are about bariatric surgery and pertain to their use in laparoscopic gastric bypass. The authors conclude that the use of barbed suture is as safe as the use of conventional sutures, while allowing for faster and simpler suturing in gastrojejunal anastomosis.
In colorectal surgery they have been used safely in the closure of the pelvic cavity after an abdominoperineal amputation and in the closure of the rectal wall after transanal endoscopic microsurgery.
Several cases have been described in the literature of obstructive symptoms secondary to the use of barbed sutures, possibly due to the contact of the barbed material with intestinal loops and its capacity to hold them, as a result of its surface characteristics. Surgeons must keep this hypothetical problem in mind, with a high level of suspicion in the case of postoperative symptoms of obstruction. It is therefore advisable to avoid contact with the material as far as possible, and it is recommended that its distal end be cut as close as possible to where it protrudes from the tissue.
Barbed sutures can facilitate surgical practice, avoiding the need to tie knots within the body as well as the need for assistants to maintain continuous tension in the suture.
This translates into an improvement in key aspects of surgery such as reproducibility, operating time and surgeon fatigue.
The principles of tension, vascularization and perfect surgical technique must be followed regardless of the material used.
The review of the literature supports their use as a safe and effective technique, which is at least equivalent to conventional absorbable sutures. However, prospective, controlled and randomized studies are needed to confirm these findings.