Use of barbed suture in surgery and the risk of intestinal obstruction: analysis of a large institutional cohort

Richard Sassun; Dovile Cerkauskaite; Annaclara Sileo; Lindsey Zhang; Kevin T Behm; Nicholas P McKenna; William R G Perry

doi:10.1007/s00464-026-12580-4

Use of barbed suture in surgery and the risk of intestinal obstruction: analysis of a large institutional cohort

Surg Endosc. 2026 Jan 14. doi: 10.1007/s00464-026-12580-4. Online ahead of print.

Authors

Richard Sassun^{1

2}, Dovile Cerkauskaite¹, Annaclara Sileo^{1

2}, Lindsey Zhang¹, Kevin T Behm¹, Nicholas P McKenna¹, William R G Perry³

Affiliations

¹ Division of Colon and Rectal Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA.
² General Surgery Residency Program, University of Milan, Milan, Italy.
³ Division of Colon and Rectal Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA. Perry.William@mayo.edu.

PMID: 41535449
DOI: 10.1007/s00464-026-12580-4

Abstract

Background: Barbed sutures have become increasingly popular across multiple surgical specialties due to their self-anchoring design, which eliminates the need for knot tying and reduces operative time. However, concerns persist that exposed barbs may cause postoperative intestinal obstruction by entangling adjacent bowel loops or mesentery. The true incidence of such events in large surgical populations remains unclear.

Methods: A retrospective analysis was conducted using an institutional database encompassing all intra-abdominal surgeries performed with barbed sutures from August 2017 to April 2024 at Mayo Clinic facilities. Patient records were screened to identify readmissions and reoperations for intestinal obstruction. Operative notes were reviewed to determine whether barbed sutures were implicated. The primary outcome was barbed suture-related intestinal obstruction; secondary outcomes included all-cause readmission and abdominal exploration for any reason.

Results: Among 20,260 patients (mean age 58.2 ± 14.7 years; 56.9% female) who underwent intra-abdominal surgery using barbed sutures, 2496 (12.3%) were readmitted. Intestinal obstruction was diagnosed in 264 patients (1.3%), and 102 (0.5%) underwent reoperation for obstruction. An additional 177 patients (0.9%) underwent abdominal exploration for other indications. Across all 279 reoperations, no case of obstruction was attributable to barbed suture use. Alternative etiologies included adhesions, anastomotic leaks, abscesses, bleeding, or hernias.

Conclusions: In this large single-institution cohort of over 20,000 patients, barbed sutures were not associated with intestinal obstruction due to small bowel entrapment. Despite over 260 readmissions for obstruction and nearly 300 abdominal re-explorations, no case was linked to suture entrapment. These findings support the safety of barbed sutures for intra-abdominal use across multiple surgical disciplines and challenge the perception that they predispose to intestinal obstruction.

Keywords: Abdominal surgery; Barbed suture; Intestinal obstruction; Reoperation.