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A prospective, randomized controlled trial of the use of an anal purse-string suture to decrease contamination during

Daniel H Biller1, Nathan L Guerette, James F Bena

  • 1Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.

International Urogynecology Journal and Pelvic Floor Dysfunction
|April 13, 2007
PubMed
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An anal purse-string suture effectively prevents fecal contamination during vaginal surgery. This surgical technique significantly reduces operative field contamination, enhancing patient safety in pelvic reconstructive procedures.

Area of Science:

  • Gynecology
  • Surgical Innovation
  • Patient Safety

Background:

  • Vaginal surgery, particularly for posterior compartment repair, carries a risk of fecal contamination.
  • Maintaining a sterile operative field is crucial for preventing surgical site infections and ensuring optimal outcomes.
  • Current methods to minimize contamination during these procedures may have limitations.

Purpose of the Study:

  • To assess the clinical effectiveness of an anal purse-string suture in preventing fecal contamination.
  • To compare contamination rates in vaginal surgery patients with and without the anal purse-string suture.
  • To evaluate the impact of the suture on surgical site contamination and patient outcomes.

Main Methods:

  • A randomized controlled trial involving 40 patients undergoing vaginal surgery for posterior compartment defects.

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  • Patients were assigned to either receive an anal purse-string suture (group 1) or not (group 2).
  • Gross fecal contamination was the primary outcome, with perineal/perianal cultures serving as secondary measures.

    • Main Results:

    • Gross fecal contamination occurred in 0% of patients with the suture versus 26.3% without (P = 0.015).
    • While not statistically significant, fecal flora contamination was lower in the suture group (10% vs. 25%).
    • No differences were observed in age, parity, operative time, or blood loss between groups.

    Conclusions:

    • The anal purse-string suture is a highly effective method for reducing fecal contamination during vaginal pelvic reconstructive surgery.
    • Implementing this simple surgical technique can significantly improve the sterility of the operative field.
    • This approach holds promise for enhancing patient safety and potentially reducing surgical site infections in relevant procedures.