STAPLES VS SUBCUTICULAR SUTURES FOR SKIN CLOSURE IN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY
Basrah Journal of Surgery,
2021, Volume 27, Issue 1, Pages 66-70
AbstractInguinal hernia repair can be achieved by many techniques but skin closure still limited to only two methods; sutures and staples. In spite of that both have the same role in healing by approximation of skin edges; they differ in terms of cost, pain, cosmoses, wound complications,and time of wound closure.Two groups, each contain 50 patients were studied regarding inguinal hernia repair by using subcuticular suturing or staples for skin closure. The time of closure, cost, infection rate, pain at removal and scar acceptance were assessed and compared in the two groups.The mean time was shorter in staples group (8.77 min. Vs 2.35 min.) with a p-value <0.05.Stapler cost was significantly higher than sutures (12 USD VS 2 USD) and p<0.05. Infection rate was more with sutures than staples (8% VS 4%) however it was with no significant difference (p>0.05). Pain difference was significant at time of removal assessed by visual analog scale score which is mild with staples and moderate with sutures (p<0.05). No much difference in scare acceptance between the two groups with more than 90% good scar in both(p>0.05).In conclusion, staples are good alternatives to subcuticular sutures in closure of skin incision in inguinal hernia repair. They are associated with good cosmetic results, less pain at removal, less wound infection and shorter time of wound closure but there is a need to reduce their cost.Key words: Staples, Sutures, Skin closure, Wound complications
Introduction n order to ensure an optimal wound healing, we need to choose a proper closure technique and material1 . An essential aspect of wound closure technique is approximation of skin edges together in order to get a good functional and cosmetic outcome. This approximation should be achieved without affecting the natural process of wound healing. The traditional method for skin closure was done with suture materials due to its availability and cost effectiveness but the current trend goes towards a faster, easier and cosmetically better methods. The advancement in wound closure includes in addition to modified suturing technique, also the use of tissue glues, skin staplers and adhesive tapes2 . Repair of inguinal hernia is the most common elective surgical procedure done by general surgeons with Lichtenstein open hernioplasty being the most popular approach performed nowadays3,4 . In spite of many techniques by which hernia repair is achieved; skin wound closure still limited to one of two techniques, either closure by sutures or by skin staples. Both of them assist healing by approximation of skin edges during the healing period5 . There are many studies conducted aiming at comparing the difference between these two methods IStaples Vs subcuticular sutures for skin closure Ali G Mohammed Redha, Adil A Jaber & Aqeel M Nassir Bas J Surg,June, 27, 2021 67 in terms of pain, wound infection, cosmetic acceptability and time needed for skin closure6-9 . The aim of this study is to evaluate the outcome of skin incisions in inguinal hernia repair after closure either by subcuticular sutures or by skin staples trying to reach a conclusion about which method is better than the other from personal experience and comparing our results with the published literature. Patients and methods This is a prospective comparative study conducted in Al-Fayhaa Teaching Hospital in Basrah, Iraq between March 2017 and January 2020. Total number of patients included in the study was 100, all of them were males diagnosed with unilateral inguinal hernia by full history taking, clinical examination and ultrasound examination if indicated. The age range was between 18 and 70 years, patients out of this range were excluded from the study. Other exclusion criteria included patients with complicated inguinal hernias such as obstruction or strangulation, patients with diabetes, immune compromised patients (on chronic steroids or chemotherapy), and patients with body mass index more than 35kg/m2. The study was approved by local ethical committee and informed consents were taken from all patients before surgical interventions. Following a complete preoperative investigations and anesthetic assessment, the surgery was done in the morning list as an elective procedure under general or spinal anesthesia with 1 gram ceftriaxone infusion before skin incision. Hernia repair was done through a skin incision of about 7-10 cm length. In skin closure, patients were allocated blindly by envelope method into 2 groups: group 1, in whom the closure of skin was done by 2-0 nylon subcuticular sutures, and group 2 in whom the skin closure was done by metallic skin staples. The time taken for skin closure was calculated by using a stop watch and recorded in the operative notes. For group 1, the number of nylon sutures used for skin closure were also recorded (for estimation of the cost), while in group 2, a single use skin stapler was needed for each patient. On discharge, Oral antibiotic treatment was prescribed for 7 days and an outpatient or clinic visits were arranged on day 5 and day 10 for dressing change and examination for any wound infection. Sutures and staples were removed on the 10th postoperative day and pain at time of removal was assessed by Visual Analog Score Scale for pain. Examination of scar acceptability was done 2 months after surgery. Chi Square test was used to assess any significant difference between the two groups. A p-value of <0.05 indicates significant difference and p-value <0.001 indicates high significant difference.
1.Dennis C, Sethu S, Nayak S, Mohan L, Morsi YY, Manivasagam G. Suture materials - Current and emerging trends. J Biomed Mater Res A. 2016 Feb 10. 61 (7):151-3. 2. Shaikh S, M ,Singh M, Panchabhai V, Dhaigude D, Bhushan A. Scar cosmesis after skin closure of inguinal hernia with stainless steel staples compared to conventional sutures. MedPulse International Journal of Surgery. August 2017; 3(2):63-66. 3.Calabrese EJ. Historical foundations of wound healing and its potential for acceleration: dose-response considerations. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2013;21(2):180-93. 4. Hetzer FH, Hotz T, Steinke W, Schlumft R, Decutins M and Largiader F. Gold Standard for Inguinal Hernia repair: Shouldice or Linchtenstein. Hernia1999; 3: 117-120. 5. Aabakke AJ, Krebs L, Pipper CB, Secher NJ. Subcuticular suture compared with staples for skin closure after cesarean delivery: a randomized controlled trial. Obstetrics and gynecology. 2013;122(4):878-84. 6. Iavazzo C, Gkegkes ID, Vouloumanou EK, Mamais I, Peppas G, Falagas ME. Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials. The American surgeon. 2011;77(9):1206-21. 7. Krishnan R, MacNeil SD, MalvankarMehta MS. Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis. BMJ Open 2016;6:e009257. doi:10.1136/bmjopen-2015- 009257 ▸ Prepublication hist. 8.Agilinko J, Tan P. A double-blinded randomised controlled trial - do subcuticular non-absorbable skin sutures have a better aesthetic outcome than skin staples in large wound closures? GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW. 2019 ;8:Doc16. 9.Ranaboldo CJ, Rowe-Jones DC. Closure of laparotomy wounds: skin staples versus sutures. Br J Surg. 1992 Nov;79(11):1172-3. 10.Kumar R, Hastir A, Goyal S, Walia RS. Sutures versus staplers for skin closure of midline incision in laparotomy patients and their outcome. Int J Surg Med. 2017; 3(4): 211-215. 11.Batra J, Bekal RK, Byadgi S, Attresh G, Sambyal S, Vakade CD. Comparison of Skin Staples and Standard Sutures for Closing Incisions After Head and Neck Cancer Surgery: A Double-Blind, Randomized and Prospective Study. J Maxillofac Oral Surg. 2016 Jun;15(2):243-50. 12. Varghese F, Gamalial J, Kurien JS. Skin stapler versus sutures in abdominal wound closure. Int Surg J 2017;4:3062-6. 13. Sharma G , Prasher, N. Sutures versus staplers for skin closure in laparotomy patients: a prospective study. Int J of Res Med Sci.2020; 8: 2149-52.10.18203/2320-6012.ijrms20202258. 14.Mackeen AD, Khalifeh A, Fleisher J, Vogell A, Han C, Sendecki J, Pettker C, Leiby BE, Baxter JK, Sfakianaki A, Berghella V; Cross Consortium. Suture compared with staple skin closure after cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2014 Jun;123(6):1169-75. 15.Ananda BB, Vikram J, Ramesh BS, Khan HM. A comparative study between conventional skin sutures, staples adhesive skin glue for surgical skin closure. Int Surg J 2019;6(3):775-782. 16. Kathare SS, Shinde ND. A comparative study of skin staples and conventional sutures for abdominal skin wound closures. Int Surg J 2019;6:2168-72. 17.Deepak R Chavan, B. B. Metan, Sachin Kadlewad, Bharath S. “Study of Skin Staples and Conventional Sutures for Abdominal Clean Wound Skin Closure: A Randomized Control Trial”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 20, May 19; Page: 5626-5636. 18.Medina dos Santos LR, Freitas CAF, Hojaji FC et al. Prospective study using skin staplers in head and neck surgery. Am J Surg. 195; 170-451-452. 19. Orlinsky M, Goldberg RM, Chan L, Puertos A, Slager HL. Cost analysis of stapler versus suturing for skin closure. Am J Emerg Med 1995; 13:77-81. 20.Kanagaye JT, Vance CW, Chan L, Schonfeld N. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. J Pediatr. 1997; 130:813. 21.Tuuli Methodius G, Rampersad Roxane M, Carbone Jeanine F, David S, Macones George A, Odibo Anthony O. Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery: A Systematic Review and Meta-Analysis. Obstet Gynecol. 2011;117(3):682-90. 22. Smith TO, Sexton D, Mann C, Donell S. Meta analysis of stapler verse sutures. BMJ. 2010;340:c1199. 23. Gohiya A, Gupta DC, Gaur S. Comparative Study of Outcome of two Methods (Sutures Vs Staples) of Skin Closure in Orthopedic Surgery. Int J Med Res Rev 2015;3(1):16-22. 24. Rajasenthil V, Sriraman K B, & Kaliyappa C. Comparative study of time taken for skin closure, infection rate and postoperative pain in skin closure with sutures and staplers in open inguinal hernioplasty. International Journal of Research in Pharmaceutical Sciences.2020;11(2): 1352-1357. 25.Geeta S. , Kamal S. , Ankur K. , Dhirajkumar B. A Comparative Study of Stapled Vs Subcuticular Vs Simple Interrupted Closure of Inguinal Hernia Incision. IOSR Journal of Dental and Medical Sciences2016;9(15):97-105
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