BARB Suture vs Prolene suture for repair of ventral hernias
| Discussion in 'All Categories' started by Dr. Karan Shankar - Apr 21st, 2025 3:43 pm. | |
Dr. Karan Shankar
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Does Barb suture causes recurrence or does the serrated thread causes damage to the abdominal wall when compared with suturing with Prolene sutures? Please help me throw some light into this |
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re: BARB Suture vs Prolene suture for repair of ventral hernias
by Dr B S Bhalla -
Nov 19th, 2025
12:00 pm
#1
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Dr B S Bhalla
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Does Barbed Suture Increase Recurrence Compared to Prolene? No sir, barbed sutures (V-Loc, Stratafix, Trubarb, etc.) do not increase recurrence when used correctly for: • Hysterectomy vault closure • Continuous peritoneal closure • Fascia approximation (in select cases) • Myometrial closure Why recurrence does NOT increase 1. Uniform tension distribution – Barbed sutures maintain equal tension along the entire line, unlike Prolene where tension is at knots. 2. No knot slippage – Vault dehiscence or fascial gap is usually due to knot-related issues. Barbed sutures eliminate knots. 3. Better tissue approximation – Continuous, even bites reduce weak points. 4. Stronger initial hold – Immediate mechanical grip without needing to tie a knot. Clinical data Multiple randomized trials in TLH show: • No increase in vault prolapse • No increase in cuff dehiscence • No increase in recurrence of pelvic floor defects For hernia repair, recurrence depends on mesh overlap and fixation, not the orientation of barbs. ⸻ Does the serrated surface damage the abdominal wall? Misconception clarification The barbs do not cut through fascia or muscle. They are micro-anchors that hold the tissue without a knot. Why they don’t cause damage • Barbs engage only the first 1–2 mm of tissue. • They distribute force over multiple small points, not a single knot point. • They cause less ischemia than tight Prolene knots. • They do not act like a saw because traction is unidirectional. Situations where barbed sutures may cause issues Only if: • You take too small bites in thin fascia (can cheese-wire under tension) • You close a high-tension midline laparotomy (Prolene still preferred) • You overtighten continuously (barbed sutures hold strongly) Important surgical principle For laparoscopic port closure, barbed sutures are usually not recommended because: • Fascia is small • Tension is high on a single point • Better to use Prolene No.1 with simple interrupted or figure-of-8 ⸻ Where Barbed Sutures Are Excellent • TLH vault closure • Uterovesical peritoneum • Sacrocolpopexy peritonealization • Myomectomy uterine closure (barbs help maintain tension) • Layered continuous suturing They reduce operative time and improve uniform approximation. ⸻ Where Prolene Is Superior • Midline laparotomy fascia (high tension) • Hernia repair fascial closure • Port site fascial closure (especially >10 mm ports) • Mesh fixation in high-tension points |
