Staples Versus Sutures for Skin Closure in Standard Four Port Laparoscopic Cholecystectomy: A Prospective Cohort Study

Introduction Many studies have been done comparing sutures versus skin staples in various wounds. To the author's knowledge, there is no study comparing these two in an laparoscopic cholecystectomy (LC) wound. Our study aims at comparing the clinical outcome of skin closure by monofilament nylon suture and stainless-steel skin stapler in standard four-port LC. The results of this study can help in developing guidelines for skin closure in LC. Objective To compare the clinical outcome of skin closure by monofilament nylon suture and stainless-steel skin stapler in standard four-port LC. Methods The study was conducted as a time-bound prospective cohort study on diagnosed patients of cholelithiasis admitted in a single unit of the Department of Surgery at All India Institute of Medical Sciences, Rishikesh, India from February 2018 to February 2019. The standard four-port LC was done by the same surgeon. After the completion of the surgery, port closure was done using absorbable sutures, and skin was closed by either 2.0 monofilament nylon suture (Ethilon, Ethicon, Scotland) or stainless-steel staples (Proximate plus MD, 35W, Ethicon, Scotland). The time taken for skin closure in both the groups was noted using a stopwatch. Each wound was assessed on the post of day (POD) 1 during discharge, on POD 10 during suture/stapler removal, and POD 30 by the operating surgeon for pain, wound infection, scar status using validated scales. Statistical analysis used The outcome measures were calculated as mean and standard deviation. Continuous variables were analyzed using a two-tailed student t-test. Results Out of 48 suture vs 45 stapler cases the average time for closure is 277.14 seconds in suture vs 77.2 seconds (p = 0.0001) in the stapler group. All other parameters studied were not statistically significant among the two cohorts. Conclusion We conclude that stapler requires minimum time for closure with no statistically significant difference in wound infection, post-op pain, pain during removal, and scar results are the same in both the groups.