Abstract
BackgroundIn an elective laparoscopic surgery, the cosmetic outcome becomes increasingly important. We conducted a study to evaluate the cosmetic outcome 3 months after a laparoscopic procedure and compared skin adhesive (SA) versus transcutaneous suture (TS).MethodsA randomized, controlled, prospective study was conducted at a single study centre in Hamburg, Germany. Seventy-seven patients undergoing laparoscopic surgery with two lower abdominal port sites met the study requirements. It was decided randomly which port site would be closed with SA. The opposite site was closed with TS. Wounds were assessed after 7–12 days and after 3 months. Cosmetic outcome was measured by a visual analogue scale (VAS) completed by the patient, by the Hollander wound evaluation scale (HWES) and by the judgement of blinded investigators.ResultsSeventy-seven subjects were randomized. Complete data from the 3-month follow-up visit were available from 56 patients (72.7 %). The VAS scale ranged from 0 to 100 mm with “0” representing the best possible cosmetic outcome. Median satisfaction was 2 mm in the TS group and 3 mm in the SA group. The mean was high in both groups 4.6 (s = 13.1) versus 3.8 mm (s = 4.6). The outcome was neither clinically nor statistically significant. Cosmetic outcome was assessed by an investigator, and the HWES showed no difference. In regard to complications, no difference was found between SA and TS, either.ConclusionsIn conclusion this study demonstrated that closure of laparoscopic port-site wounds leads to equivalent outcomes whether SAs or TSs are used. Complications are rare in both methods. Thus, SAs seem to be a valid alternative to sutures in laparoscopic surgery.Registration site: www.clinicaltrials.gov.Registration number: NCT02179723.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-015-4474-5) contains supplementary material, which is available to authorized users.
Highlights
In an elective laparoscopic surgery, the cosmetic outcome becomes increasingly important
In conclusion this study demonstrated that closure of laparoscopic port-site wounds leads to equivalent outcomes whether skin adhesive (SA) or transcutaneous suture (TS) are used
SAs seem to be a valid alternative to sutures in laparoscopic surgery
Summary
In conclusion this study demonstrated that closure of laparoscopic port-site wounds leads to equivalent outcomes whether SAs or TSs are used. Even though single-incision laparoscopic surgery has been projected to have better cosmetic outcomes compared with conventional laparoscopic procedures, there are no convincing data to support this [1–3]. When a new skin adhesive (Leukosan AdhesiveÒ, BSN medical GmbH) recently became available in Germany, we conducted a study to compare skin adhesive versus transcutaneous sutures in laparoscopic port-site incisions. Transcutaneous sutures as a comparator were chosen as a previous study performed in our clinic had shown that transcutaneous sutures in laparoscopic surgery seemed to be the most suitable technique for the closure of laparoscopic port-site incisions compared with subcuticular sutures and adhesive tapes [5]. The present study is the first randomized clinical trial comparing skin adhesive versus transcutaneous suture which was designed to evaluate the cosmetic outcome as the primary endpoint at 3 months after the laparoscopic procedure
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