Cosmetic outcome of skin adhesives versus transcutaneous sutures in laparoscopic port-site wounds: a prospective randomized controlled trial

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.

Comparison of 2-Octylcyanoacrylate Versus 5-0 Fast-Absorbing Gut During Linear Wound Closures and the Effect on Wound Cosmesis

“…23 Similarly, several recent trials have demonstrated that wound closure with OCA offers comparable scar cosmesis compared to repair with sutures. [24][25][26][27][28][29] In accord with our results, a 2014 Cochrane review and meta-analysis found that wound closure with tissue adhesives resulted in significantly more episodes of wound dehiscence than sutures. 30 Strengths of this study include its use of a validated scar assessment tool by blinded observers, a priori data analysis, and larger sample size relative to similar published studies.…”

A randomised clinical trial to compare octyl cyanoacrylate with absorbable monofilament sutures for the closure of laparoscopic cholecystectomy port incisions

“…Cosmetic outcome was also evaluated at the 1-and 4-week visit by POSAS and MHCS (Table 2). Wounds were judged slightly better in the 11.43 (10)(11)(12)(13) .005…”

“…Optimal OCA group than in the transcutaneous suture group. Patients' median POSAS was 9.45 (6-11) and 11.43 (10)(11)(12)(13) in the OCA and suture groups, respectively (P = .005), and surgeon's median POSAS was 9.42 (6-11) and 11.48 (10)(11)(12)(13) in the OCA and suture groups, respectively (P = .006). Furthermore, elevated levels of cosmetic were equally reported for all wounds despite of sealing device with no statistical significance between the two groups at the 4-week visit (Figure 4).…”

n-Butyl-2-cyanoacrylate tissue adhesive (Histoacryl) vs. subcuticular sutures for skin closure of Pfannenstiel incisions following cesarean delivery

“…Previous studies to suggest the efficacy of tissue adhesive comparable to convetional suture have focused on the skin closure of small incisional surgical wound such as laparoscopic port site or thyroidecomty [ 17 , 18 ]. Using tissue adhesives in major surgeries involving long skin incisions was recently founded to be safe in breast surgery and abdominoplasty [ 19 , 20 ].…”

“…However, given that scar formation is occurring at this time, the excellent cosmetic outcome achieved after NCBA closure is meaningful. Many studies have reported that tissue adhesives resulted in the same or better cosmetic outcomes and no increase in wound complications compared to suture closure [ 15 , 17 – 20 ].…”