Page 15 - World Journal of Laparoscopic Surgery

Barbed vs Polyglactin 910: A Comparative Study of the Efficacy in Laparoscopic Vaginal Cuff Closure
potential to become an asset in gynecological surgery. The purpose Most common medical comorbidity noted among the patients
of this study is to compare the efficacy of barbed suture with that was diabetes mellitus (n = 4) followed by hypertension (n = 3).
of Polyglactin 910 for vaginal cuff closure in patients undergoing Among 27 patients with a history of previous abdominal surgery,
total laparoscopic hysterectomy (TLH) at our hospital. 19 (70%) patients had undergone LSCS and 5 patients had a history
of appendicectomy. No statistical significance was noted between
MAterIAls And Methods the two groups in terms of medical comorbidity and previous
This comparative study includes 100 patients who underwent abdominal surgery.
Table 2 depicts the indication of surgery in both groups. Uterine
total laparoscopic hysterectomy during a period of 12 months. fibroid was the most common indication for surgery in both the
Considering 1-year statistics at our hospital for laparoscopic groups followed by endometrial hyperplasia.
hysterectomies, i.e., 147 and compensating dropouts, 100 was taken The average time taken for suturing vaginal vault was 6.9
as the sample size, with 50 in each group.
minutes (SD = 1.27 minutes) while using polyglactin 910 suture,
2
S Z pq / d 2 whereas in group II where barbed suture was used, the suturing
time was 5.39 minutes (SD = 0.76 minutes) with a significant p value
/

1.96 1.96 0.08 0.92 0.05 0.05 of <0.0001. Significant reduction in the difficulty of operation was

113 noted while using barbed sutures for vault closure. The degree of
surgical difficulty was lower in the group using barbed sutures (VAS
Following approval by the institutional ethics committee, of 3.5 vs 8; p value < 0.001) (Table 3).
patients diagnosed with benign gynecological conditions were There were three intraoperative complications reported of
included and those excluded were malignancies, infected masses, which two cases had bladder injury due to previous LSCS and
and immunocompromised status. The patients were selected by one case had a rectal serosal injury due to dense endometriotic
simple random sampling to avoid bias and were divided into two adhesions. These were not related to the suturing technique but
groups (50 each). were related to the surgical difficulty due to adhesions. All patients
All patients were admitted 4 to 6 hours before surgery after were discharged on the second postoperative day other than the
detailed preoperative workup. TLH in both groups were performed patients with intraoperative complications who stayed longer for
by the same surgeon following standard surgical technique. After further management.
removal of the uterus, needles were introduced and the vaginal
vault closed with continuous intracorporeal sutures using Barbed dIscussIon
suture No.1/Polyglactin 910 No.1, where suture was taken starting Hysterectomies have been performed vaginally, abdominally, or
from the right side through vaginal angle incorporating the with laparoscopic or robotic assistance. Laparoscopic hysterectomy
right uterosacral, anteriorly through vaginal mucosa followed by has many proven benefits over the other traditional methods,
posterior vaginal mucosa up till the left uterosacral and left vaginal such as shorter hospital stays, faster resumption of routine
angle. Then, the needles were removed through the peripheral activities, lower intraoperative blood loss, and fewer wound
trocars. infections. However, longer operative duration and higher rates
3
Intraoperatively, mean suturing time, defined as the time taken of complications, such as secondary hemorrhage, lower urinary
from beginning of the first stitch and cutting of the last stitch, was tract injuries, and vaginal cuff dehiscence, have been reported
noted and compared between the two groups. The amount of more in laparoscopic than abdominal hysterectomy probably
blood loss was recorded intraoperatively. The difficulty perceived
by the surgeon in operating was graded using a visual analog scale Table 1: Demographic and clinical details of 100 patients
(VAS) ranging from 1 (low difficulty) to 10 (high difficulty). Incidence
of intraoperative complications were noted. Postoperatively, the Polyglactin 910 Barbed group
duration of hospital stay was noted. All patients were advised group (n = 50) (n = 50) p value
sexual abstinence and avoid heavy lifting of weights for 6 weeks Age (years), mean (SD) 45.74 (4.96) 44 (6.29) 0.12
2
after surgery. BMI (kg/m ), mean (SD) 26.77 (2.20) 26.45 (2.02) 0.44
Statistical analysis was carried out using Student t test for Medical comorbidity 5 (10%) 7 (14%) 0.5
continuous variables and Fischer exact test for categorical variables. Previous abdominal 17 (34%) 10 (20%) 0.1
p values ≤ 0.05 were considered significant. surgery n (%)

results Table 2: Indications for hysterectomy
A total of 100 women undergoing total laparoscopic hysterectomy Polyglactin 910 Barbed group
were studied, among which 50 intracorporeal vaginal cuff closures group (n = 50) (n = 50)
were performed using polyglactin 910 sutures (group I), while Fibroid uterus 26 (52%) 20 (40%)
another 50 women (group II) were sutured with barbed sutures. Endometrial hyperplasia 10 (20%) 6 (12%)
Comparison between demographic characteristics is listed in Adenomyosis 7 (14%) 6 (12%)
Table 1. Endometrial polyp 2 (4%) 12 (24%)
Mean age of women in group I was 45.74 years (SD = 4.96 Endometriosis 3 (6%) 4 (8%)
years) and that in group II was 44 years (SD = 6.29 years) without
significant differences in age. There was no significant difference PID 0 (0%) 2 (4%)
in BMI between the two groups, although 6 patients belonged Fibroid with endometriosis 1 (2%) 0 (0%)
2
to the obese category with BMI in the range of 30 to 34.9kg/m . Chronic cervicitis 1 (2%) 0 (0%)

114 World Journal of Laparoscopic Surgery, Volume 13 Issue 3 (September–December 2020)