Knotless barbed suture is associated with fewer short-term cesarean scar defects compared with conventional suture in a randomized controlled trial

Cesarean scar defect (CSD) is a common consequence of cesarean section (CS). There is limited evidence of short-term effects of knotless barbed suture on CSD in pregnant women underwent cesarean section (CS). This study aimed to evaluate acute effect of knotless barbed suture on CSD in pregnant women underwent CS. This was a single-center, open-label, randomized controlled trial compared between knotless barbed suture versus conventional suture. The inclusion criteria were pregnant women with an age of 18 years or over, had no history of cesarean delivery, and underwent CS. The primary outcome was the presence of CSD at 6–8 weeks after delivery. There were 39 pregnant women enrolled in the knotless barbed suture group and 40 pregnant women in the conventional suture group. The knotless barbed suture group had significantly lower rate of CSD than the conventional suture group (18.2% vs. 43.8%; p = .026) but not the uterine position or large CSD. Regarding the parameters of CSD, the knotless barbed suture group had thicker residual myometrium thickness (8.5 vs. 5.3 mm; p = .011) and thicker total myometrium thickness (13.9 vs. 10.9 mm; p = .009) than the conventional suture group. There were no significant differences of CSD and its parameter among three surgeons. The knotless barbed group had significantly shorter operation time (30.8 vs. 38.5 min; p < .001) than the conventional suture group. The knotless barbed suture in CS had fewer CSD and better surgical outcomes than the conventional suture in the short-term period. The disadvantage of the knotless barbed suture was higher price than the conventional suture.