To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis

Abstract

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.

Keywords: Laparoscopic surgery; Skin closure; Surgical staples; Suture; Tissue adhesive.

Fig. 1

Study flow diagram

Fig. 2

Risk of bias

Fig. 3

Relative risk of postoperative wound dehiscence in randomized controlled trials on efficacy of optimal wound closure of abdominal laparoscopic port sites. Relative risk (RR) < 1 favor intervention group. CI = Confidence intervals

Fig. 4

Relative risk of postoperative infection in randomized controlled trials on efficacy of optimal wound closure of abdominal laparoscopic port sites. Relative risk (RR) < 1 favor intervention group. CI = Confidence intervals

Fig. 5

Relative risk of postoperative wound drainage in randomized controlled trials on efficacy of optimal wound closure of abdominal laparoscopic port sites. Relative risk (RR) < 1 favor intervention group. CI = Confidence intervals

Fig. 6

Relative risk for postoperative erythema in randomized controlled trials on efficacy of optimal wound closure of abdominal laparoscopic port sites. Relative risk (RR) < 1 favor intervention group. CI = Confidence intervals

Fig. 7

Relative risk of postoperative pain in randomized controlled trials on efficacy of optimal wound closure of abdominal laparoscopic port sites. Relative risk (RR) < 1 favor intervention group. CI = Confidence intervals

Fig. 8

Relative risk for postoperative HWES (Hollander Wound Evaluation Score) in randomized controlled trials on efficacy of optimal wound closure of abdominal laparoscopic port sites. Relative risk (RR) < 1 favor intervention group. CI = Confidence intervals

Fig. 9

Mean difference for cosmesis as assessed by VAS at 90 days in randomized controlled trials investigating the efficacy of optimal wound closure of abdominal laparoscopic port sites. Negative values favor intervention. MD = Mean difference. CI = Confidence intervals

Fig. 10

Relative risk of postoperative dissatisfaction in randomized controlled trials on efficacy of optimal wound closure of abdominal laparoscopic port sites. Relative risk (RR) < 1 favor intervention group. CI = Confidence intervals