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Comparison of laparoscopic port site skin closure techniques (CLOSA): transcutaneous suturing versus subcuticular sutures versus adhesive strips: a prospective single-blinded randomized control trial

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Abstract

Background

Cosmesis is an essential aspect of laparoscopic surgery. Various methods of skin closure techniques have been described. We conducted a study to evaluate the cosmesis and patient satisfaction with the scars three months after laparoscopic surgery using transcutaneous suture (TS) vs. adhesive strips (AS) and subcuticular suturing (SS).

Methods

A randomized, controlled, prospective study was conducted at AIIMS, Bhubaneswar. The included patients were randomly assigned among the three arms. The time for skin closure was measured. Wounds were assessed till discharge, at 14 days, one month, and three months. Cosmesis was measured by the Hollander Wound evaluation scale (HWES) for each incision separately, and patient satisfaction by a 10-

point Visual analog scale (VAS).

Results

One hundred six patients were assessed for eligibility, and 90 patients were randomized. Three-month follow-up data was obtained from 83 patients (92.22%). Baseline characteristics were similar among the groups. Cosmetic outcome was assessed in 312 incisions across 83 patients, and 206 (66.03%) incisions had an HWE Score of 0, but there was no significant difference (p = 0.86). Patient satisfaction was highest in the TS group (TS = 1.29, SS = 1.79, AS = 2.04, p = 0.03). Time for skin closure was the least in the AS arm (41.4 secs, p = 0.00). Skin dehiscence was significantly more in the AS arm. Four (4.44%) patients had port site infections.

Conclusion

This study demonstrates that skin closure by transcutaneous, subcuticular, or adhesive strip methods had comparable cosmetic outcomes at three months. However, the transcutaneous closure method showed better patient satisfaction and minimal post-operative complications.

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Data Availability

Raw data supporting the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

We are in humble debt to the patients who had participated in this study and for their faith in us.

We would like to give special thanks to Dr. Manash Ranjan Sahoo, Head of the Department, for providing us with ample opportunity and scope to conduct the study with full fervour and ensure that the protocols were being adhered to. Without Sir's guidance and encouragement, it would have been impossible to conduct and complete the study.

Our sincere gratitude to all the faculties Dr. Shantanu K. Sahu, Dr. Mithilesh K. Sinha, Dr. Bikram Rout and Dr. Monika Gureh, who have helped us collect the data and also for their guidance and support.

A special word of thanks goes to Dr. Ankit Sahoo, Dr. Siddhant Sarthak, Dr. Mahesh Sethi, Dr. Harshavardhan H.P., Dr. Vikram VS, Dr. Chiranjeevi H, Dr. Swastik S. Mishra, Dr. Pranav Joshi, Dr. Madhuri KV, Dr. Sanhita Panigrahi, Dr. Ankit Shetter, Dr. Preeti K. Gond and Dr. Umesha R, Dr. Bhargavi, Dr. Pravanjan, Dr. Ankit Rana, Dr. Sai Krishna, Dr. ShriGanesh and Dr. Medhavi, who have supported us in data collection and follow-up. This study would not have been possible without the support of the anaesthesiology team and the nursing staff in the elective OT complex. We would like to thank all the nursing staff in the OPD, OT and Ward for being supportive in the process.

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Authors and Affiliations

  1. Department of General Surgery, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar, 751019, India

    Pradeep Kumar Singh, Kallol Kumar Das Poddar, Prakash Kumar Sasmal, Pankaj Kumar, S. Manwar Ali & Tushar Subhadarshan Mishra

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  1. Pradeep Kumar Singh
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  2. Kallol Kumar Das Poddar
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Contributions

Dr. Pradeep, Dr. Kallol, and Dr. Prakash conceptualised the study, did review of the literature, and prepared the study protocol. All the authors followed all the patients. Dr. Pradeep and Dr. Kallol did the data collection. Dr. Pradeep, Dr. Kallol, and Dr. Prakash prepared the draft manuscript and analysed the data. The final manuscript was prepared after review by all the co-authors.

Corresponding author

Correspondence to Pradeep Kumar Singh.

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The authors declare no competing interests.

Disclosures

Dr. Pradeep Kumar Singh, Dr. Kallol Kumar Das Poddar, Dr. Prakash Kumar Sasmal, Dr. Pankaj Kumar, Dr. S. Manwar Ali and Dr. Tushar Subhadarshan Mishra have no conflicts of interest or financial ties to disclose.

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Singh, P.K., Das Poddar, K.K., Sasmal, P.K. et al. Comparison of laparoscopic port site skin closure techniques (CLOSA): transcutaneous suturing versus subcuticular sutures versus adhesive strips: a prospective single-blinded randomized control trial. Langenbecks Arch Surg 408, 228 (2023). https://doi.org/10.1007/s00423-023-02950-0

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