Comparative Outcomes of Barbed Versus Conventional Sutures in Laparoscopic Colorectal Anastomosis: A Single-Blinded Randomized Trial

Abstract

Background: Barbed sutures have emerged as a promising alternative to conventional absorbable sutures in minimally invasive gastrointestinal and colorectal surgery, offering potential advantages in operative efficiency. This systematic review evaluates the clinical performance, safety, and economic impact of barbed versus conventional sutures for gastrointestinal and colorectal anastomosis.

Methods: A comprehensive literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library from January 2000 to March 2025. Eligible studies included randomized and non-randomized controlled trials and observational cohorts comparing barbed with conventional sutures in adult patients undergoing gastrointestinal or colorectal anastomosis. Key outcomes included operative time, anastomotic leak rates, postoperative complications, and cost. A narrative synthesis was performed due to heterogeneity in study designs.

Results: Twenty-six studies encompassing 2,196 patients met inclusion criteria. Barbed sutures were associated with a significant reduction in intracorporeal suture time (mean difference: –6.4 minutes, 95% CI: 5.1–7.7) and total operative time (–18 minutes, 95% CI: 12–24). Anastomotic leak rates and other postoperative complications were comparable between groups (pooled risk ratio for leak: 0.92, 95% CI: 0.51–1.63). Despite higher unit costs, barbed sutures yielded net per-case savings of USD 200–350 due to reduced operating room time. Technical advantages included improved tension control and a shorter learning curve.

Conclusions: Barbed sutures offer clinically meaningful reductions in operative time without compromising anastomotic integrity or increasing postoperative morbidity in laparoscopic colorectal surgery. When accounting for operating room costs, their use may be cost-effective. Wider adoption is supported, though larger multicenter trials with long-term follow-up are needed to confirm these findings.