Skin closure methods after single port laparoscopic surgery: a randomized clinical trial

• Published in: European journal of obstetrics & gynecology and reproductive biology 2015-06, Vol.189, p.8-12
• Main Authors: Park, Sue Yeon, Kim, Kye Hyun, Yuk, Jin-Sung, Ji, Hyun Young, Lee, Jung Hun
• Format: Article
• Language: English
• Subjects: Adult; Cicatrix - pathology; Cosmesis; Dermatologic Surgical Procedures; Female; Genital Diseases, Female - surgery; Humans; Laparoscopy; Laparoscopy - methods; Middle Aged; Obstetrics and Gynecology; Patient Satisfaction; Prospective Studies; Scar assessment scale; Single port surgery; Skin - pathology; Suture Techniques; Sutures; Umbilicus - pathology; Wound Closure Techniques
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2015.03.014

Abstract Objective To compare postoperative cosmetic outcomes according to different umbilical closure methods after single port laparoscopic surgery (SP-LS). Study design A total of 138 women who were scheduled to receive elective SP-LS were randomized to undergo closure of the umbilical incision with either a subcutaneous suture only without subcuticular skin suture (case group, n = 68) or both a subcutaneous suture and subcuticular skin suture (control group, n = 70) after fascial closure. At postoperative months 1 and 3, the umbilical scar was evaluated using the Vancouver scar scale (VSS), the patient and observer scar assessment scale, and a visual analog scale (VAS). Overall satisfaction with scar cosmesis and surgery was assessed with the VAS. Results There was no significant difference in the clinical characteristics and operative data between the groups. The objective and subjective scar assessments and the overall satisfaction with scar cosmesis were not different between the groups. In the control group, four (5.7%) women experienced wound discharge and were treated with conservative treatments and delayed closure. In women who completed the first and second assessments, the changes in the scar assessment and overall satisfaction with the scar according to time after surgery were not different in either group, but the patient scar assessment scale in both groups and the VSS in the case group improved. Conclusions After SP-LS, the approximation of the fascia and subcutaneous layer seems to be enough for the closure of an umbilical incision. Skin closure with subcuticular sutures did not improve the postoperative cosmetic outcomes and might lead to impaired wound healing. However, large randomized trials with various closure techniques and materials are needed to confirm this finding.