Barbed Suture Versus Polyglactin Suture for Laparoscopic Closure of Vaginal Vault after Total Laparoscopic Hysterectomy: A Prospective Observational Comparison

Objective: To assess the ease of vaginal cuff closure with barbed suture and polyglactin suture in total laparoscopic hysterectomy (TLH). Design: A prospective observational study. Materials and Methods: All women who underwent TLH for benign conditions from September 2018 to June 2020 were included in the study. Vaginal cuff closure was performed laparoscopically with either unidirectional barbed suture or with polyglactin suture. Time taken for vaginal cuff closure with barbed suture or polyglactin suture was noted during surgery. Vault was examined at the time of discharge and at 6 weeks during which postoperative vaginal cuff complications such as infection, discharge, bleeding, and dehiscence were assessed. Results: A total of 120 patients undergoing TLH were included, out of which polyglactin was used in 65 cases and barbed suture in 55 cases. The median time taken for vaginal cuff closure was 16.2 (14-18) minutes in the polyglactin group and 9.5 (8.2-11.4) minutes in the barbed suture group, and the difference was statistically significant (p < 0.001). In the polyglactin group, the incidence of composite vaginal cuff complication was 6.15% compared with 5.45% in the barbed group (p > 0.99). The median duration of hospital stay was 3 (2-3) days in both the groups. Conclusion: Barbed suture makes laparoscopic vaginal cuff closure faster without any increase in the rate of postoperative complications. Hence it can be an effective alternative over polyglactin for vaginal cuff closure in TLH.