STAPLES VS SUBCUTICULAR SUTURES FOR SKIN CLOSURE IN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY

Mohammed Redha, Ali G; Jaber, Adil A; Nassir, Aqeel M

doi:10.33762/bsurg.2021.168440

	STAPLES VS SUBCUTICULAR SUTURES FOR SKIN CLOSURE IN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY
Basrah Journal of Surgery
Article 12, Volume 27, Issue 1 - Serial Number 54, 2021, Pages 66-70
DOI: 10.33762/bsurg.2021.168440
Authors
Ali G Mohammed Redha^* ; Adil A Jaber; Aqeel M Nassir
Department of Surgery, Al-Fayhaa Teaching Hospital, Basrah, IRAQ.
Abstract
Inguinal 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). 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.
Keywords
Staples; Sutures; Skin closure; Wound complications

Full Text
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
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