Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions.

Abstract

The purpose of this study is to determine whether closure of laparoscopic port-site incisions using octylcyanoacrylate (OCA) is feasible, whether it is faster than traditional subcuticular suturing, whether the number and length of incisions impact on closure time, and to determine wound morbidity and patient satisfaction outcomes. A prospective randomized trial was performed on adult patients scheduled for elective laparoscopic surgery in three surgical specialties at a tertiary referral center. Patients were randomized to have closure of laparoscopic port sites using either OCA or sutures. Patients were followed up 2 to 3 weeks postoperatively. At 2 months patients were mailed a questionnaire regarding their satisfaction with the method of closure and the appearance of their scars. A total of 175 incisions in 50 patients were closed with OCA, and 142 incisions in 42 patients were closed with subcuticular sutures. Time to close was significantly faster for OCA (median 2.5 minutes versus 6 minutes, p < 0.001). OCA was faster than traditional subcuticular suturing for cases involving three or more port sites (median 2.5 minutes versus 6 minutes, p < 0.001), and for cases with total length of incisions >4 cm (median 2.6 minutes versus 7 minutes, p < 0.001). OCA and subcuticular suturing groups did not differ significantly on patient acceptance or assessment of scars. Closure of laparoscopic port-site incisions is feasible with OCA. Closure with OCA requires significantly less operative time than subcuticular suturing, particularly in cases when three or more port sites are used or when total incision length is greater than 4 cm. OCA appears to have equivalent adverse wound outcomes and patient acceptance rates as subcuticular suturing.