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Published on: June 25, 2013
Four Techniques for Closing Laparoscopic Ports in Obese Patients
Milton Alberto Muñoz-Leija1,2, Jesús Gabriel Rosales-Vázquez1, Gabriel Rosales-Pérez3
1Division of General Surgery, General Hospital of Zone #6, Mexican Social Security Institute; Nuevo Leon, Mexico. (Drs. Muñoz-Leija and Rosales-Vázquez).
Objective:
The study objective was to compare the complication rates of four different techniques for closure: (1) no closure, (2) conventional closure with Vicryl, (3) Carter-Thomason, (4) M-Close in patients with obesity.
Methods:
The study design is a retrospective comparison of four surgical cohorts. All results refer to 12-mm supraumbilical incisions after laparoscopic surgery in patients with obesity. All patients had at least 12 months of follow-up.
Results:
Second surgery for a hernia was performed in 7 (12%) of 57 no-closure patients, 4 (8%) of 53 conventional closure patients, 1 (3%) of 31 Carter-Thomason patients, and 0 of 118 M-Close patients (overall difference: P < .001). The 95% confidence interval for these percentage rates of second surgery for hernia was: 5.3-21.1% for no closure, 1.9-15.1% for conventional closure, 0-9.7% for Carter-Thomason, and 0-0% for M-Close. Noteworthy differences for other complications were also found.
Conclusions:
This study suggests that M-Close reduces the rate of second surgery for hernia. The results also reinforce guideline recommendations that all incisions 10 mm or larger should be closed. This report provides a basis for planning randomized comparative trials.
