The Use of Barbed Suture for Cystotomy Repair --- A Novel Approach

Abstract Background In this study, we aim to compare outcomes after cystotomy repair between standard sutures (910 polyglactin, poliglecaprone) versus barbed (V-Loc™ 90) suture. As a secondary outcome, we analyzed risk factors for suture preference between the two groups. Methods A retrospective chart review was undertaken for surgeries complicated by cystotomy, identified by ICD-9/10 codes from 2016 to 2019 at West Virginia University (WVU) Hospital. Comparisons were made between cystotomy repair using barbed suture versus standard braided suture. Injuries were categorized by procedure, surgeon specialty, surgical route, type of suture used in repair, and subsequent complications related to repair. Primary endpoints were examined by Pearson’s Chi-square test and interval data by t-test. A p < .05 was significant. Results Sixty-eight patients were identified with iatrogenic cystotomy at WVU. Barbed suture was used for cystotomy repair in 11/68 (16.2%) patients. No significant difference was seen in postoperative outcomes between patients repaired with barbed suture versus standard braided suture. Barbed suture was significantly more likely to be used for cystotomy repair in minimally invasive surgery (p = 0.001). It was most often utilized in a robotic approach 7/11 (63.6%) followed by laparoscopic 3/11 (27.3%). Body mass index (BMI) was significantly higher in patients receiving a barbed suture repair (p = .005). Conclusion Barbed suture is not inferior to standard braided suture for cystotomy repair and does not cause an increase in complication rate. Barbed suture offers a practical alternative to facilitate cystotomy repair in minimally invasive surgery, especially in patients with a high BMI.