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

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.

Preoperative Mechanical Bowel Preparation for Abdominal, Laparoscopic, and Vaginal Surgery: A Systematic Review.

STUDY OBJECTIVE: Mechanical bowel preparation (MBP) continues to be widely used in gynecologic surgery, with the aim of reducing postoperative complications and improving the viewing and handling conditions in the surgical field. It is reported that MBP is an unpleasant patient experience and may be associated with adverse effects such as dehydration and electrolyte imbalance. This review evaluates the use of preoperative MBP compared with no MBP in adult patients undergoing open abdominal, laparoscopic, or vaginal surgery. Although the focus is on the use of MBP for gynecologic procedures, data from other surgical areas are covered when relevant. DESIGN: A comprehensive search of the databases Medline (from 1946), EMBASE (from 1947), PubMed, Cochrane Library Central (Register of Controlled Trials), and Google Scholar was performed to identify any randomized controlled trials (RCTs) and prospective or retrospective cohort studies comparing preoperative MBP to no MBP. RESULTS: Forty-three studies were identified in various surgical specialties, of which there were 5 RCTs in gynecology. The gynecologic studies reported no benefit for MBP in operative time or improved surgical field of view but did report a more unpleasant patient experience when MBP is used. RCTs from colorectal and urologic surgery were powered for infectious morbidity and anastomotic leak and did not demonstrate improved patient outcomes when MBP was used. CONCLUSION: Evidence from high-quality trials reports no or few benefits from MBP or rectal enema across surgical specialties. In the field of gynecologic surgery, high-quality evidence supports the view that MBP may be safely abandoned.