A comparative study of laparoscopic port site skin closure Versus skin adhesives

Prasanna, S (2016) A comparative study of laparoscopic port site skin closure Versus skin adhesives. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Minimally invasive techniques have grown leaps and bounds over the past decade. This occurred as a result of patient demands for less painful operations quicker postoperative recovery and technological development. Any general surgical procedure can be done using laparoscopic procedures. Surgeries in the chest, upper abdomen, and pelvis, especially those not requiring tissue removal, are ideally suited for laparoscopic techniques. Conversely, other procedures may have lesser known benefits when minimally invasive techniques are performed, especially when the specimen excised is large. Traditionally, laparoscopic trocar sites were closed either by subcuticular sutures or a simple skin suture depending on the surgeon. The other methods in which the port closure is being carried out are skin staples, surgical tape,full thickness cuticular sutures and skin adhesives. Cyano acrylates were actually used as tissue adhesives in operative set up. Easy appication, cost-effectiveness, cosmesis all make it a valuable asset in wound closure. Skin adhesives are being used extensively in the closure of extremity, head, and neck lacerations. Use of cyanoacrylates in otologic and ophthalmologic surgery are also being described. Octylcyanoacrylate is a long- chain cyanoacrylate tissue adhesive. It is a combination of monomer and plasticizers which form a flexible bond with a breaking strength comparable to 5-0 monofilament suture. Multiple clinical applications for which it is commonly being used exist. However, no studies exist to compare its use in closing laparoscopic port sites. AIMS AND OBJECTIVES : 1. To establish the applicability of octyl cyanoacrylate in laparoscopic surgery for swift closure of trocar sites by comparing it with conventional suturing. 2. To reduce the operating time and to reduce the economic strain with reference to repeated change of dressings and to produce cosmetically better wounds. MATERIALS AND METHODS : PLACE OF STUDY: Department of General Surgery, Govt. Stanley Medical College & Hospital,Chennai DURATION: JAN 2015 TO SEP 2015 TYPE OF STUDY: Prospective study SAMPLE SIZE – 50 INCLUSION CRITERIA: All Patients undergoing laparoscopic surgeries irrespective of age group both in the emergency and elective setup EXCLUSION CRITERIA: • Cases in which the laparoscopic procedure is converted to open technique • Patients who are known to harbor atypical mycobacteriae • Patients who are terminally ill • Patients previously diagnosed with tuberculosis • Patients diagnosed with AIDS, Hepatitis etc ; METHODOLOGY : • All patients undergoing laparoscopic surgeries in our department during the period from January 2015 to September 2015 were included in the study • After any laparoscopic surgery the 5 mm ports alone were not sutured instead a skin adhesive ( octyl cyanoacrylate) was applied after approximating the wound edges. The port site is left open without applying any dressing. The patients were followed in the 5 th and 14 th postoperative days for any signs of inflammation like redness , induration, blisters, scars etc; the results were compared with ports which were closed by conventional suturing by 2 –o vicryl simple intermittent sutures. • The observations were recorded and tabulated. CONCLUSION: • The use of cyanoacrylate for skin closure in laparoscopic skin incisions is effective, cosmetically better and economical.It is much quicker to close these port sites with octylcyanoacrylate than by sutures. • The technique for closure is easy to learn and not technically demanding. This leads to shorter overall operating times, lower cost, and greater efficiency in wound closure. Even if the adhesive used gets in between the wound edges it gets extruded just like any foreign body. Nevertheless , the skin adhesive is always used after approximating the wound edges. • Low wound complication arose possibly due to bacteriostatic properties of tissue adhesives. Both n-2- butylcyanoacrylate and 2-octylcyanoacrylate demonstrate antimicrobial effects against gram-positive organisms.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Laparoscopy ; 5mm port closure ; octyl cyanoacrylate.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 27 Sep 2017 02:34
Last Modified: 27 Sep 2017 02:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/3381

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