Efficacy of laparoscopic barbed sutures in the repair of gastroduodenal perforations: a meta-analysis

BACKGROUND: Laparoscopic repair of gastroduodenal perforation has been widely used in clinical practice. With the advent of barbed sutures, the position of traditional absorbable sutures has been challenged, but the superiority of one over the other in terms of clinical outcomes remains unclear. AIM: To evaluate the efficacy and safety of laparoscopic barbed sutures in the repair of gastroduodenal perforations through a meta-analysis. METHODS: A systematic review, including randomized controlled trials (RCTs) and case‒control studies, was conducted following PRISMA guidelines. From the PubMed, Web of Science, Embase, Cochrane, CNKI, CDDB, and CSTJ databases up to August 23, 2024, relevant studies comparing laparoscopic barbed sutures to conventional sutures were identified. The primary outcomes were suturing time and operative duration, whereas the secondary outcomes included hospital stay and postoperative complications. Sensitivity analysis was conducted to evaluate the robustness of the findings, and publication bias was examined via Egger's test complemented by the trim-and-fill method. The study was registered on the platform Prospero with the ID CRD42024591576. RESULTS: Five studies with 436 patients were included. Barbed sutures significantly reduced the operative time [standard mean difference (SMD: -0.89; 95% CI: -1.38-0.40; p < 0.001) and suturing time (SMD: -1.31; 95% CI: -1.91-0.71; p < 0.001) without increasing the risk of postoperative complications, such as anastomotic leakage, intestinal obstructions, or intra-abdominal abscesses. Additionally, no significant differences were observed in hospital stay. CONCLUSION: The use of barbed sutures in laparoscopic repair of gastroduodenal perforation offers significant advantages in reducing the operative time and simplifying the suturing process without compromising patient safety or increasing the incidence of postoperative complications. High-quality randomized controlled trials are needed for further validation. CLINICAL TRIAL NUMBER: PROSPERO registration number: CRD42024591576.