Peer-reviewed veterinary case report
Barbed sutures for hiatal hernia repair - what to know?
By Clapp B et al.·2026·El Paso Bariatric Surgery·View original on Europe PMC →
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Original publication title: Barbed Sutures at the Hiatus: What's the Evidence?
Plain-English summary
This study looked at the use of barbed sutures, which allow for a type of surgery called cruroplasty (repair of the diaphragm) without needing knots, in fixing hiatal and paraesophageal hernias in adults. Researchers reviewed several studies and found that using barbed sutures can make the stitching process faster, although the overall time for the surgery didn't change much. When barbed sutures were used with a special mesh, there was a significant decrease in the chances of the hernia coming back after a year compared to using barbed sutures alone. However, the evidence available is limited and varied, so more research is needed to fully understand the safety and effectiveness of this method. Overall, the findings suggest that barbed sutures may be helpful, especially when used with mesh, but more studies are necessary to confirm these results.
Abstract
<h4>Background</h4>Barbed sutures enable knotless, continuous cruroplasty and are increasingly used in hiatal and paraesophageal hernia repairs. Despite widespread adoption, outcome data specific to the hiatus are limited and diaphragmatic application remains off-label.<h4>Methods</h4>A systematic search of PubMed and MEDLINE (inception-August 2025) identified adult hiatal/paraesophageal hernia repairs using barbed sutures. Data on operative approach, mesh use, operative time, recurrence, and perioperative outcomes were extracted. The FDA MAUDE database (2010 to 2025) was reviewed for device-related events.<h4>Results</h4>Five studies (n=741) met the inclusion criteria. In laparoscopic comparisons, barbed sutures shortened per-stitch closure time compared with interrupted silk, although total closure time was not significantly different. In pooled analysis of 4 comparative studies, the weighted mean difference in operative time was +12.8 minutes (95% CI: -4.3 to 29.8; P =0.14; I ²=40%). Individual series demonstrated variable findings: operative time increased with mesh reinforcement but not when mesh was avoided ( P =0.45). One study reported that barbed cruroplasty with biosynthetic mesh reinforcement significantly reduced ≥1-year anatomic recurrence (24.7% vs. 44.9%; risk difference -20.3%, 95% CI: -33.7 to -7.0) and symptomatic recurrence (17.2% vs. 42.2%, P =0.003) compared with barbed suture-only repair. Postmarket surveillance analysis of the FDA MAUDE database (2010 to 2025) identified only 2 hiatal-specific adverse events associated with barbed sutures, although underreporting is likely.<h4>Conclusions</h4>Barbed sutures for cruroplasty appear time-efficient and may lower recurrence when combined with mesh in larger hernias. However, current evidence is sparse, heterogeneous, and based largely on retrospective series. Given the off-label nature of diaphragmatic use, prospective studies with standardized recurrence definitions are needed to clarify safety and long-term efficacy.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41528014