Efficacy and Safety of Barbed Sutures versus Standard Fixation Techniques using Tackers in Laparoscopic Ventral and Incisional Hernia Repair: A Prospective, Single Blinded, Randomized Controlled Trial

Background: The success of laparoscopic hernia repair relies on effective mesh fixation methods. Objectives: To determine the efficacy and safety of barbed sutures versus standard fixation techniques using tackers in laparoscopic ventral and incisional hernia repair. Methods: This was a single centre, hospital based, prospective, single blinded, randomized controlled trial conducted in the Department of General Surgery of a tertiary teaching healthcare facility in South India between January 2023 and June 2024. Results: This study involved 80 patients undergoing elective laparoscopic hernia repair, with 40 patients in Group A (tackers group) and 40 in Group B (suture group). Both groups were comparable in terms of age, gender distribution, BMI, comorbidities, hernia type, defect location, and defect size, with no significant differences observed. The mean mesh fixation time was significantly (p<0.05) shorter in Group A (23.4 minutes) compared to Group B (44.2 minutes), and the total operative time was also shorter in Group A (62.1 minutes) than in Group B (83.5 minutes). Surgical site infections occurred more frequently in Group A (12.5%) than in Group B (2.5%), though this difference was not statistically significant. Group A also had a significantly higher need for rescue analgesia (72.5% vs. 40.0%). While recurrence was noted in 7.5% of Group A, no recurrences were observed in Group B. Postoperative pain, measured using the Visual Analogue Scale (VAS), was consistently lower in Group B from postoperative day 1 onwards, with significant differences observed at all time points, including at 1-month, 3-month, and 6-month follow-ups (p<0.05). Conclusion: These results suggest that barbed sutures may offer a significant advantage in reducing postoperative pain compared to tackers.