Evaluating the use of absorbable sutures versus sTaples versus tIssue glue in laparoscopic port skin closure (STILS) trial: A prospective, multi-centre randomised clinical trial (RCT).
Sinead E Ramjit, Matthew G Davey, Stephen Keelan, Emer Herlihy, Marie Dromey, Chris Garvey, Timothy S Nugent, Aisling Fawaz, Lauren O'Connell, Melanie Cunningham, Matthew Fahy, Eanna J Ryan, Brendan Moran, Lylas Aljohmani, Jeyanthi Narayanasamy, Michael E Kelly, Clara Healy, Claire Donohoe, Narayansamy Ravi, Paul Neary, John V Reynolds, Noel E Donlon
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引用次数: 0
Abstract
Methods: This prospective, multi-centre RCT was conducted in accordance with the CONSORT guidelines for prospective, parallel group randomised studies. Adult patients undergoing elective laparoscopic surgery at two teaching hospitals in Dublin, Ireland were recruited and assigned to one of three closure methods (sutures (SU), staples (ST) or tissue glue (TG)) with primary outcome being cosmesis and secondary outcomes being closure speed, wound complications, cost effectiveness and sustainability outcomes being assessed by a blinded outcomes assessor.
Results: A total of 147 patients were recruited and randomised with a total of 138 being examined in the final analysis (SU = 48, ST = 63, TG = 27). Patient demographics were similar across all groups for gender, mean age, body mass index and American Society of Anaesthesiologists grade (all p > 0.050). For cosmesis, SU had the lowest overall mean observer (p < 0.001) and patient (p = 0.005) scar scores. Furthermore, when evaluating the breakdown for Observer Scar Score (OSS), SU had the lowest vascularity (p = 0.001), pigmentation (p = 0.006), thickness (p < 0.001), relief (p = 0.003) and pliability (p < 0.001). For patient scar score (PSS), SU had the lowest irregularity (p = 0.035). SU was the most cost-effective (p < 0.001) and had the lowest total produced non-recyclable waste (p < 0.001). ST had the shortest closure time (p < 0.001). Overall, there was a no difference in wound complication rates (SU = 6.3 %, ST = 6.4 %, TG = 18.5 %; p = 0.130).
Conclusion: In conclusion, SU was the most effective method for laparoscopic port site closure with regards to cosmesis, cost-efficiency and surgical sustainability. ST was the marginally quicker method of closure and demonstrated equipoise in terms of complication rate. We advocate for SU as the current 'gold standard' with reduced non-recyclable waste generated and a valuable training opportunity for junior trainees.
期刊介绍：
Since its establishment in 2003, The Surgeon has established itself as one of the leading multidisciplinary surgical titles, both in print and online. The Surgeon is published for the worldwide surgical and dental communities. The goal of the Journal is to achieve wider national and international recognition, through a commitment to excellence in original research. In addition, both Colleges see the Journal as an important educational service, and consequently there is a particular focus on post-graduate development. Much of our educational role will continue to be achieved through publishing expanded review articles by leaders in their field.
Articles in related areas to surgery and dentistry, such as healthcare management and education, are also welcomed. We aim to educate, entertain, give insight into new surgical techniques and technology, and provide a forum for debate and discussion.
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