Cargando…
To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis
BACKGROUND: Previous meta-analyses examining skin closure methods for all surgical wounds have found suture to have significantly decreased rates of wound dehiscence compared to tissue adhesive; however, this was not specific to laparoscopic wounds alone. This study aims to determine the best method...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9485090/ https://www.ncbi.nlm.nih.gov/pubmed/35610480 http://dx.doi.org/10.1007/s00464-022-09269-9 |
_version_ | 1784792014830698496 |
---|---|
author | Aitchison, Lucy P. Chen, Andy Z. L. Toms, Clare Sandroussi, Charbel Yeo, David A. Steffens, Daniel |
author_facet | Aitchison, Lucy P. Chen, Andy Z. L. Toms, Clare Sandroussi, Charbel Yeo, David A. Steffens, Daniel |
author_sort | Aitchison, Lucy P. |
collection | PubMed |
description | BACKGROUND: Previous meta-analyses examining skin closure methods for all surgical wounds have found suture to have significantly decreased rates of wound dehiscence compared to tissue adhesive; however, this was not specific to laparoscopic wounds alone. This study aims to determine the best method of skin closure in patients undergoing laparoscopic abdominopelvic surgery in order to minimize wound complications and pain, while maximize cosmesis, time and cost efficiency. METHODS: A comprehensive search of EMBASE, Medline, Pubmed, and CENTRAL was conducted from inception to 1st May 2020 for randomized controlled trials (RCTs). Two independent reviewers extracted data and assessed risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to describe the quality of evidence. Meta-analysis was performed using a random-effects model. A summary relative risk (RR) was calculated for dichotomous outcomes where data could be pooled. (Prospero registration number: CRD42019122639). RESULTS: The literature search identified 11,628 potentially eligible studies. Twelve RCTs met inclusion criteria. There was no difference in wound complications (infection, dehiscence, and drainage) between sutures, tissue adhesives nor adhesive papertape. Low-quality evidence found transcutaneous suture had lower rates of wound complications compared with subcuticular sutures (RR 0.22, 95%: CI 0.05–0.98). There was no evidence of a difference in patient-evaluated cosmesis, prolonged pain, or patient satisfaction between the three groups. Closure with tissue adhesive and adhesive papertape was faster and cheaper than suture. CONCLUSION: Tissue adhesive and adhesive papertape offer safe, cost and time-saving alternatives to closure of laparoscopic port sites compared to suture. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09269-9. |
format | Online Article Text |
id | pubmed-9485090 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-94850902022-09-21 To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis Aitchison, Lucy P. Chen, Andy Z. L. Toms, Clare Sandroussi, Charbel Yeo, David A. Steffens, Daniel Surg Endosc Review Article BACKGROUND: Previous meta-analyses examining skin closure methods for all surgical wounds have found suture to have significantly decreased rates of wound dehiscence compared to tissue adhesive; however, this was not specific to laparoscopic wounds alone. This study aims to determine the best method of skin closure in patients undergoing laparoscopic abdominopelvic surgery in order to minimize wound complications and pain, while maximize cosmesis, time and cost efficiency. METHODS: A comprehensive search of EMBASE, Medline, Pubmed, and CENTRAL was conducted from inception to 1st May 2020 for randomized controlled trials (RCTs). Two independent reviewers extracted data and assessed risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to describe the quality of evidence. Meta-analysis was performed using a random-effects model. A summary relative risk (RR) was calculated for dichotomous outcomes where data could be pooled. (Prospero registration number: CRD42019122639). RESULTS: The literature search identified 11,628 potentially eligible studies. Twelve RCTs met inclusion criteria. There was no difference in wound complications (infection, dehiscence, and drainage) between sutures, tissue adhesives nor adhesive papertape. Low-quality evidence found transcutaneous suture had lower rates of wound complications compared with subcuticular sutures (RR 0.22, 95%: CI 0.05–0.98). There was no evidence of a difference in patient-evaluated cosmesis, prolonged pain, or patient satisfaction between the three groups. Closure with tissue adhesive and adhesive papertape was faster and cheaper than suture. CONCLUSION: Tissue adhesive and adhesive papertape offer safe, cost and time-saving alternatives to closure of laparoscopic port sites compared to suture. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-022-09269-9. Springer US 2022-05-24 2022 /pmc/articles/PMC9485090/ /pubmed/35610480 http://dx.doi.org/10.1007/s00464-022-09269-9 Text en © Crown 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Review Article Aitchison, Lucy P. Chen, Andy Z. L. Toms, Clare Sandroussi, Charbel Yeo, David A. Steffens, Daniel To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis |
title | To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis |
title_full | To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis |
title_fullStr | To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis |
title_full_unstemmed | To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis |
title_short | To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis |
title_sort | to stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9485090/ https://www.ncbi.nlm.nih.gov/pubmed/35610480 http://dx.doi.org/10.1007/s00464-022-09269-9 |
work_keys_str_mv | AT aitchisonlucyp tostitchornottostitchtheskinclosureoflaparoscopicportsitesametaanalysis AT chenandyzl tostitchornottostitchtheskinclosureoflaparoscopicportsitesametaanalysis AT tomsclare tostitchornottostitchtheskinclosureoflaparoscopicportsitesametaanalysis AT sandroussicharbel tostitchornottostitchtheskinclosureoflaparoscopicportsitesametaanalysis AT yeodavida tostitchornottostitchtheskinclosureoflaparoscopicportsitesametaanalysis AT steffensdaniel tostitchornottostitchtheskinclosureoflaparoscopicportsitesametaanalysis |