Surgical Benefits of Bidirectional Knotless Barbed Sutures over Conventional Sutures for Uterine Repair During Cesarean Section-A Meta-analysis of Randomized Controlled Trials

To analyze the surgical benefits of bidirectional knotless barbed suture (BS) compared with conventional sutures for uterine closure during cesarean section. The databases were searched using the following keywords: "Cesarean Section," "Uterine closure," "Barbed suture" and "Conventional suture." Randomized control trials reporting the comparison of bidirectional knotless BS with conventional sutures for closing uterine incision were included. The outcome measures were closing time of uterine incision, the number of additional hemostatic sutures used, blood loss parameters, and the total duration of surgery. A random or fixed-effects model was used to obtain the pooled estimates using the inverse variance method. The heterogeneity was assessed using the I2 test and the GRADE approach was used to assess the quality of evidence. Out of 15 full-text assessed, three randomized controlled trials were included. We observed significantly short uterine incision closure time with BS [standardised mean difference -1.51; 95% confidence interval (CI): -1.97, -1.06; I2=64%; GRADE approach evidence: Moderate], significantly lesser need of additional hemostatic sutures (risk ratio: 0.39; 95% CI: 0.28, 0.54; I2=0%; GRADE approach evidence: High) and significantly less blood loss during uterine incision closure [-0.47 (95% CI:-0.75, -0.19); I2 =0%; GRADE approach evidence: moderate]. with no significant difference in total blood loss, the need of blood transfusion, and total duration of surgery. The use of bidirectional knotless BS for uterine closure can reduce suturing time and the additional suture requirement.