{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T06:11:02Z","timestamp":1781849462412,"version":"3.54.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009933","name":"Ethicon","doi-asserted-by":"publisher","award":["WC-2019-14"],"award-info":[{"award-number":["WC-2019-14"]}],"id":[{"id":"10.13039\/100009933","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify the effect of fascial closure using barbed sutures on the incidence of incisional hernia in patients undergoing elective midline laparotomy for gynecological diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicenter, non-blind randomized controlled trial conducted from February to December 2021, patients with a BMI\u2009&lt;\u200935\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and aged &gt;18 years, scheduled for midline laparotomy, were randomly assigned to receive either barbed (experimental) or non-barbed sutures (control) for fascial closure. The primary outcome was the cumulative incidence rate of incisional hernia up to 1-year post-surgery. Secondary outcomes included incisional hernia up to 2-years post-surgery, wound complications, and postoperative pain assessed by Brief Pain Inventory-Korean scores, and Numeric Rating Scale.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 174 patients (experimental, 86; control, 88), 36 were excluded due to dropout or loss to follow-up, leaving 138 patients (experimental, 67; control, 71) included in the analysis. The groups were balanced in terms of cancer surgeries, mean wound length, and mean surgery time. The cumulative incidence rates of incisional hernia up to 1-year (0.0% vs. 1.4%; p\u2009&gt;\u20090.999) and 2-years (0.0% vs. 3.4%, p\u2009=\u20090.496) post-surgery did not differ significantly between the experimental and control groups. Additionally, no significant differences were observed in the incidence of wound dehiscence 4 weeks post-surgery, cumulative incidences of wound dehiscence and wound infection up to 4 weeks post-surgery, or postoperative pain scores between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fascial closure using barbed sutures resulted in no cases of incisional hernia up to 2-years post-surgery, but did not demonstrate a significant reduction in incisional hernia rates compared with the non-barbed suture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04643197\" xlink:type=\"simple\">NCT04643197<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337036","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T18:32:29Z","timestamp":1763577149000},"page":"e0337036","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of fascial closure using barbed sutures on incisional hernias in midline laparotomy for gynecological diseases: A multicenter randomized controlled trial (KGOG 4001)"],"prefix":"10.1371","volume":"20","author":[{"given":"Yong Jae","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam Kyeong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9254-6024","authenticated-orcid":true,"given":"Kidong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chel Hun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keun Ho","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Min","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang Beom","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hoon","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunghoon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1937-3611","authenticated-orcid":true,"given":"Min Kyu","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok Ju","family":"Seong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myong Cheol","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"issue":"4","key":"pone.0337036.ref001","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10029-009-0518-x","article-title":"Classification of primary and incisional abdominal wall hernias","volume":"13","author":"FE Muysoms","year":"2009","journal-title":"Hernia"},{"issue":"5","key":"pone.0337036.ref002","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1002\/bjs.7398","article-title":"Randomized clinical trial comparing polypropylene or polydioxanone for midline abdominal wall closure","volume":"98","author":"A Bloemen","year":"2011","journal-title":"Br J Surg"},{"issue":"1","key":"pone.0337036.ref003","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s00464-016-4977-8","article-title":"Ventral and incisional hernia: the cost of comorbidities and complications","volume":"31","author":"MA Plymale","year":"2017","journal-title":"Surg Endosc"},{"issue":"2","key":"pone.0337036.ref004","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.amjsurg.2012.01.012","article-title":"Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study","volume":"204","author":"GH van Ramshorst","year":"2012","journal-title":"Am J Surg"},{"key":"pone.0337036.ref005","unstructured":"Network NCC. 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