Barbed Sutures Are Associated With a Lower Incidence of Incisional Hernia Compared With Continuous Non‐Barbed Monofilament Sutures After Minimally Invasive Gastroenterological Surgery

ABSTRACT Aim Although barbed sutures have been proposed to improve fascial closure, their superiority over conventional, continuous, slowly absorbable sutures remains unclear. Therefore, we compared the incidence of incisional hernia (IH), a common complication of minimally invasive gastroenterological surgery, after using the two suture types. Methods We retrospectively analyzed patients who underwent elective minimally invasive gastroenterological surgery requiring a midline incision between 2021 and 2025. The patients were divided into barbed suture (ST) and continuous slowly absorbable monofilament suture (PC) groups. The primary outcome was the incidence of IH at 1 year, as assessed using computed tomography. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance the baseline characteristics. Results A total of 255 patients were included in this study (142 and 113 in the PC and ST groups, respectively). IPTW adjustment balanced the baseline characteristics. The incidence of IH at 1 year was significantly lower in the ST group than that in the PC group. Weighted logistic regression demonstrated that barbed sutures were associated with a reduced risk of IH (odds ratio, 0.46; 95% confidence interval, 0.22–0.99; p  = 0.047). Among the patients who developed IH, the defect size did not differ between the groups, although all symptomatic cases occurred in the PC group. Conclusions Barbed sutures are associated with a lower incidence of IH than conventional continuous sutures after minimally invasive gastroenterological surgery. Therefore, in addition to suture selection, appropriate closure techniques and risk stratification may be important in preventing IH.