916 The Use of Absorbable Suture Versus Staples Versus Tissue Glue in Laparoscopic Port Skin Closure. a Prospective, Randomised Control Trial. the STILS Trial

Abstract

Abstract Aim The closure of surgical wounds following laparoscopic surgery is not currently standardised. The aim of this study was to compare the three main methods of closure – Stitches, Staples, and Tissue Glue to evaluate which of these produce optimum cosmetic outcomes, results in least wound complications and which is most cost-effective. This would enable the adoption of a standard protocol for closure of laparoscopic wound sites. Method This was a prospective, randomised controlled trial. Patients undergoing elective, laparoscopic surgeries were consented and randomised into one of the three treatment arms (Stitches–Subcuticular 4–0Monocryl;Skin Staples or Tissue Glue). Pre-defined, specific guidelines for each of the closure methods were followed. Data recorded at the time of surgery included: Number/Size of Port Sites, time taken and Quantity of closure material used. At an interval follow-up appointment, the wounds were evaluated using the ‘Patient and Observer Scar Assessment Scale’ (POSAS), wound complications recorded, and photographs taken to facilitate further evaluation by a third-party clinician. Results A total of 147 patients were recruited with 138 completing full follow-up. In the ‘Sutures’ arm the average Observer Scar Score(OSS) was 10.3;Patient Scar Score(PSS) was 12.6;Rate of wound closure(RWC) 4.3mm/min;Wound complication rate(WCR) 0.08%;Cost €4.22/patient. The ‘Staples’ arm demonstrated an average OSS-13.1;PSS-16.4;RWC-15.7mm/min;WCR-0.06%;Cost €21.97/patient(excluding labour for ROS). In the ‘Tissue Glue’ arm there was an average OSS-15.7;PSS-18.4;RWC-5.1mm/min;WCR-.19%; Cost €21.10/patient. Conclusions Laparoscopic port site closure with 4–0 Monocryl was most superior with regards to cosmetic outcome and cost-effectiveness. Staples was the fastest method of closure and lowest complication rate.