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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
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Poster Session 1

Category: Operative Obstetrics

Poster Session 1

(374) Beyond the Knot: VBAC Success After Knotless Barbed Versus Conventional Uterine Closure Sutures

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  

    Submitting Author and Presenting Author(s)

  • Suha Seh, MD

    Ziv Medical Center
    Israel, HaZafon, Israel

Objective:

 

To evaluate whether uterine closure with knotless barbed sutures (Stratafix) during primary cesarean delivery is associated with the rate of successful vaginal birth after cesarean (VBAC), as well as the incidence of uterine rupture and dehiscence, compared to conventional smooth sutures (Vicryl), among women undergoing a subsequent delivery at the same institution.

Study Design:

We conducted a retrospective case-control study of women who underwent a primary cesarean at Ziv Medical Center (2015–2018) and returned for a subsequent delivery. Patients were grouped based on the suture type used for uterine closure: Vicryl (smooth) vs. Stratafix (knotless barbed). Outcomes included VBAC success (primary) and rates of uterine rupture and dehiscence (secondary).

Results:

A total of 284 women were included: 213 had uterine closure with conventional smooth sutures (Vicryl) and 71 with knotless barbed sutures (Stratafix) during their primary cesarean. Baseline characteristics—age, gravidity, parity, BMI, and gestational age at subsequent delivery—were comparable between groups.

Elective repeat cesarean section (ERCS) was chosen by 117 women (55%) in the Vicryl group and 46 (65%) in the Stratafix group. Trial of labor after cesarean (TOLAC) was attempted by 96 (45%) in the Vicryl group and 31 (43%) in the Stratafix group.

VBAC success rates were similar: 79% in the Vicryl group vs. 80% in the Stratafix group. Surgical complications, including uterine dehiscence and rupture, were lower in the Stratafix group, though numbers were too small for statistical significance.

Conclusion:
Uterine closure with knotless barbed sutures (Stratafix) during primary cesarean delivery was not associated with differences in VBAC success rates or the incidence of uterine rupture and dehiscence compared to conventional smooth sutures (Vicryl). However, Stratafix may offer operative advantages, including reduced surgical time and blood loss. While these findings support the safety and potential efficiency benefits of barbed sutures, larger studies are warranted to confirm these results and strengthen clinical recommendations.