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

Association between skin suture devices and incidence of incisional surgical site infection after gastrointestinal surgery: systematic review and network meta-analysis

BACKGROUND

Surgical site infections (SSIs) are common complications after abdominal surgery.

AIM

To compare which suture devices could reduce the incidence of incisional surgical site infections (SSIs) after gastrointestinal surgery using a systematic review and network meta-analysis.

METHODS

The CENTRAL, PubMed, and ICHUSHI-Web databases were searched from January 1st, 2000, to December 31st, 2022, for randomized clinical trials (RCTs) comparing the incidence of incisional SSI after gastrointestinal surgery among patients treated with different surgical suture devices, including non-absorbable sutures, absorbable sutures, skin staplers, and tissue adhesives (last searched in August 23th, 2023). The risk of bias was assessed using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. To estimate the pooled odds ratios (ORs) for each comparison, a fixed-effect inverse-variance model based on the Mantel-Haenszel approach was employed.

FINDINGS

A total of 18 RCTs with 5496 patients were included in this study. The overall SSIs in absorbable sutures were significantly lower than those in skin staplers (OR: 0.77; 95% confidence intervals (CI): 0.63-0.95) and non-absorbable sutures (OR: 0.62; 95% CI: 0.39-0.99), whereas SSIs in absorbable sutures were not significantly different from the SSIs in tissue adhesive. The highest P-score was 0.91 for absorbable sutures. A funnel plot for estimating the heterogeneity of the studies revealed that a publication bias would be minimal (Egger test, P = 0.271).

CONCLUSION

This study showed that absorbable sutures reduced incisional SSIs in gastrointestinal surgical operations compared to any other suture devices.

Comparative Evaluation of the Aesthetic Outcomes of Octyl-2-Cyanoacrylate Skin Adhesive and Ethilon Suture in Maxillofacial Surgery - A Randomised Clinical Study

Introduction

Wound closure methods have evolved, attributed to the armamentarium including the synthetic sutures, staples, surgical adhesive tapes and, most recently, the cyanoacrylate tissue adhesives. Cyanoacrylates have shown promising results in terms of aesthetic outcomes in other fields of surgery. The aim of this study is to compare the aesthetic value of Dermabond over Ethilon suture when used in case of facial surgical incisions. The purpose of this study was to demonstrate the efficacy of Dermabond for wound closure in the head-and-neck region.

Materials and Methods

This study involved 20 subjects undergoing maxillofacial surgery. In 10 subjects, skin closure was done with conventional suturing (Ethilon) and other 10 subjects with tissue glue (2-octyl cyanoacrylate). Observations regarding skin closure time and scar assessment were made, and their results were compared.

Results

The mean time for closure in the Dermabond group was 217.2 ± 42.0 s and for Ethilon suture group was 383.3 ± 140.2 s. Dermabond was significantly better than Ethilon sutures at both 1 month and 3 months with P = 0.001 and P < 0.001, respectively. For Dermabond, the average score improved from 8.2 ± 2.5 at 1 month to 6.1 ± 1.6 at the 3rd month. The improvement was statistically significant (P = 0.001) for Ethilon sutures; the average score improved from 12.0 ± 1.2 at 1 month to 10.2 ± 2.0 at 3rd month. The improvement was statistically significant (P = 0.038).

Discussion

Adhesive glue appears to be superior to conventional suturing in clean elective surgeries. It is a safe and effective method of skin closure with less operative time and better cosmesis of the scar.

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 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.

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

Tissue adhesives have gained increasing use as a possible method of wound closure. We compared the use of 2-octyl cyanoacrylate (OCA) or subcuticular suture in incisions sutures for the closure of laparoscopic cholecystectomy port incisions. A prospective randomised controlled trial was performed. Patients were randomised to have closure of laparoscopic port sites using either OCA or sutures. Patients were reviewed at 24 hours and returned for follow-up 1 week and 1 month after postoperatively. At these times, different wound characteristics were documented: Two tools were used to measure the cosmetic result using Hollander wound evaluation scale (HWES) and the patient and observer scar assessment scale (POSAS). A total of 70 patients, 35 in each group were enrolled. The wounds were closed significantly faster in the OCA group (mean 229.16 [±43.7] seconds versus 258.82 [±51.7] seconds, P = .01). Statistically significant difference in favour of using OCA was found for dehiscence (17.1% versus none in the suture group, P = .025) after 1 week. However, no difference was found for wound dehiscence after 1 month. OCA and suture groups did not differ significantly on patient satisfaction. There were no differences in the percentage of wounds achieving optimal scores on the HWES (suture 85.7% versus OCA 74.2%, P = .169). Nerveless, wound evolution was judged to be significantly better in the OCA group using POSAS. Patients' median POSAS was 9.45 (6-11) and 11.43 (10-13) in the OCA and suture groups, respectively (P = .005), and surgeon's median POSAS was 9.42 (6-11) and 11.48 (10-13) in the OCA and suture groups, respectively (P = .006). N-butyl-cyanoacrylate tissue adhesive is an acceptable technique for the closure of laparoscopic wounds with less operative time, and cosmetic results are comparable to suturing.