What type of sutures are recommended for use in a hysterectomy?

Suture Types for Hysterectomy

For hysterectomy procedures, delayed absorbable monofilament sutures such as poliglecaprone (Monocryl) are recommended as the primary choice for uterine closure due to less bacterial seeding and reduced infection risk compared to multifilament options. 1

Uterine Closure

• Delayed absorbable monofilament sutures (e.g., poliglecaprone/Monocryl) are preferred for uterine incision closure due to less bacterial seeding and lower infection risk 1
• Alternative options include chromic catgut and polyglactin 910 (Vicryl), though evidence doesn't strongly favor one particular suture type 1
• Two-layer closure of the uterine incision may be associated with lower rates of uterine rupture in future pregnancies, though evidence is limited (recommendation grade: weak) 1

Vaginal Cuff Closure

• Both absorbable monofilament and braided sutures are effective for vaginal cuff closure 2, 3
• Bidirectional barbed sutures (e.g., Quill SRS) can safely reduce operative times compared to traditional interrupted sutures 4
• Unidirectional barbed sutures with welded-loop closure are also safe and well-tolerated alternatives 2
• Nonabsorbable sutures may reduce spontaneous vaginal cuff dehiscence compared to absorbable options (0.52% vs 1.4%), though this requires a second procedure for removal 3

Suturing Technique

• Continuous non-locking suturing techniques are preferred over interrupted sutures as they:
  • Distribute tension more evenly across the suture line 1, 5
  • Result in less short-term pain 1
  • Reduce the need for suture removal 1
  • Improve postoperative sexual function 1

Peritoneal Closure

• The peritoneum does not need to be closed during hysterectomy as:
  • Closure is not associated with improved outcomes 1
  • Non-closure reduces operative times 1
  • There is no evidence that peritoneal closure affects intra-abdominal adhesion formation 1

Subcutaneous Tissue and Skin Closure

• For subcuticular skin closure, both monofilament (Monocryl) and braided multifilament (Vicryl) sutures show comparable rates of surgical site infection and wound complications 6
• 4-0 size sutures are typically appropriate for subcuticular closure 5, 6

Potential Complications to Monitor

• Vaginal cuff dehiscence, especially within the first 90 days postoperatively 3
• Surgical site infections, which occur at similar rates with both monofilament and multifilament sutures 6
• Vaginal bleeding or spotting, which typically resolves without significant intervention 2

Key Considerations for Optimal Outcomes

• Avoid overly tight sutures that can strangulate tissue and impair healing 5
• Consider the mobility and tension of the area when selecting suture material 5
• Barbed sutures may offer advantages in reducing operative time without increasing complications 4, 7
• For high-mobility areas or tissues under tension, stronger suture materials with longer absorption profiles are preferred 5