A prospective randomized controlled study to compare the efficacy and safety of barbed sutures versus standard fixation techniques using tackers in laparoscopic ventral and incisional hernia repair.

BACKGROUND: Laparoscopic ventral and incisional hernia mesh repair (LVIHR) has become the standard of care due to shorter recovery time, low rate of complication and recurrence. The most common fixation technique for mesh is by tackers but results in patients having more pain in the early postoperative period. One modality to reduce pain has been to use intracorporeal conventional sutures but with the disadvantage of inherent difficulty in handling, suturing and knotting which is obviated by barbed sutures.

METHODS: The study was conducted over a period of two years. Sixty patients with primary ventral and incisional hernia were randomized to either fixation of mesh with barbed sutures or to tackers with transfacial sutures. Primary end points were used to evaluate and compare mesh fixation time, early postoperative pain and complications, whereas secondary end points were used to compare the incidence of chronic pain and recurrence.

RESULTS: Of the 60 patients, 51% had primary ventral hernia, and the rest had incisional hernia. Visual Analogue Scale (VAS) pain score for the barbed suture group at all intervals postoperatively was significantly lower than that for tackers. The mean time taken for fixation in the tacker group was significantly lower. Only one patient under the tacker group developed recurrence.

CONCLUSION: Barbed suture group had significantly less pain and is economical with the same rates of recurrence as compared with tackers. Hence, low pain scores, cost effectiveness and relatively easier intracorporeal suturing make barbed sutures a viable alternative for intracorporeal mesh fixation in LVIHR.