A prospective randomized trial of closing laparoscopic trocar wounds by transcutaneous versus subcuticular suture or
O Buchweitz1, P Wülfing, L Kiesel
1Department of Obstetrics and Gynecology, University of Münster, Albert-Schweitzer-Strasse 33, D-48149, Münster, Germany. buchweo@mednet.uni-muenster.de
Background:
Several methods for closure of trocar wounds are known in laparoscopic surgery. The choice of technique (mostly transcutaneous or subcuticular suture or adhesive papertape) is often based on the surgeon's personal experience. Thus, the objective of this trial was to assess the impact of these closure methods on potential complications of wound healing, cosmetic outcome, and patient satisfaction.
Methods:
Sixty patients undergoing operative laparoscopic surgery for gynecologic indications were enrolled in this prospective randomized trial. Five-millimeter port-site incisions were closed either with subcuticular or transcutaneous absorbable sutures (4-0 polyglactin 910) or with adhesive papertape. Postoperative complications, pain, and patient satisfaction with scars were evaluated at 3-month follow-up after operation using a questionnaire.
Results:
Data from 52 patients who returned the questionnaire were analyzed. Dissatisfying cosmetic results were reported significantly more frequently after subcuticular sutures (p < 0.05). Assessment of patient satisfaction with cosmetic outcome on a visual-analogue scale revealed significantly better results after transcutaneous skin closure than with other approaches (p < 0.05). Adverse wound healing (e.g., infections and dehiscence) was observed most frequently in the subcuticular suture group. Also, the rate of painful scars was highest with this technique.
Conclusions:
Transcutaneous closure with absorbable suture material seems to be the most suitable technique for closure of laparoscopic port-site incisions.
