Perineal repair: comparison of suture materials and suturing techniques

ABSTRACT

To compare the outcome of chromic catgut versus polyglactin 910 suture and of continuous versus interrupted suture technique on perineal repair. Randomized clinical Trial. Darul-Sehat Hospital [a private teaching tertiary care hospital] and the duration of study was 18 months. A total of 200 patients delivering singleton fetus and having episiotomy or second degree perineal tear were included in this study. These 200 patients were randomly allocated with alternating sequence to either of the 4 groups which were, group 1 as continuous repair with chromic catgut no. 0 and 00, group 2 as continuous repair with polyglactin 910 no. 0 and 00, group 3 as interrupted repair with chromic catgut and group 4 as interrupted repair with polyglactin 910. All the repairs were conducted by authors. Primary outcome was the subjective assessment of perineal pain on day 10, while secondary outcomes were dyspareunia at 6 weeks, resumption of sexual activity, wound healing, residual suture removal and number of sutures utilized. Analysis was performed by SPSS-15 and the ANOVA and Chi-square test were used with p-value < 0.05 as the level of significance. Of the 200 patients 50 patients had perineal repair done with chromic catgut and continuous technique, 50 with polyglactin 910 and continuous technique, 50 with chromic catgut and interrupted method and 50 with polyglactin 910 and interrupted method. At day 10 there was no significant difference [p-value > 0.05] in the pain intensity among different groups. Also there was no difference in dyspareunia, resumption of sexual activity and healing, but more cases of suture removal found in polyglactin 910 group as compared to chromic catgut, while significant difference [p-value < 0.05] was found in the number of suture utilization when compared between continuous and interrupted technique. Chromic catgut is still found to be an effective suture material for perineal repair in resource poor countries as the outcome measures are similar to polyglactin 910. Also the continuous suture technique is found to be less costly as less suture material is required without compromising the outcome: