Current Role and Outcomes of Barbed Sutures in Fascial Closure of Ventral Hernia Repair: A Multicenter Study Using the Abdominal Core Health Quality Collaborative Database

Barbed sutures (BS) have been increasingly used in the last decades but little is known about their adoption in ventral hernia repair (VHR). The aim of this study was to document the use and outcomes of BS in VHR. Prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) database (ACHQC) was retrospectively reviewed adult patients who underwent VHR with fascial closure from 2020 to 2022. A univariate analysis compared patients with BS against non-barbed sutures (NBS) across the preoperative, intraoperative, and postoperative timeframes. BS (n = 4,054) were compared with NBS (n = 6,473). BS were used in 86.2% of minimally invasive (MIS) VHR and 92.2% of robotic surgery against 9.6% of open procedures. Notable differences existed including a higher BMI (32 vs 30.5; p < 0.001), more incisional hernias (63.3% vs 51.1%; p < 0.001), wider hernias (4 cm vs 3 cm; p < 0.001), and higher ASA score (p < 0.001) in patients with BS. Outcomes in BS included a shorter LOS (1.4 vs 2.4; p < 0.001), less SSI (1.5% vs 3.6%; p < 0.001), similar SSO (7.6% vs 7.3%; p = 0.657), readmission (3.0 vs 3.2; p = 0.691), and reoperation (1.5% vs 1.45%; p = 0.855), at a longer operative time (p < 0.001). Hernia specific questionnaires for quality of life and pain in BS had a worse preoperative score that was later matched and favorable compared to NBS (p = 0.048). PRO concerning hernia recurrence suggested around 10% at two years (p = 0.532). Use of barbed sutures in VHR is widespread and highly related to MIS. Outcomes from ACHQC cannot be reported as superior but suggest safety and non-inferiority.