ABSTRACT
The aim of the study was to compare the efficacy and safety of barbed unidirectional vs. polyglactin 910 suture in vaginal cuff closure on patients submitted to total laparoscopic hysterectomy. From November 2011 until March 2012, a prolective, comparative, longitudinal, non-randomized study was performed on patients submitted to total laparoscopic hysterectomy (TLH). On entry, patients were assigned to two different groups, Group 1: Vaginal cuff closure with unidirectional #00 (n = 25) barbed suture, and Group 2: Vaginal cuff closure with polyglactin 910 #1 suture. The length of closure time and the frequency of dehiscence in vaginal vault were measured on the 14th postoperative day. We did not find significant differences between the groups on the general characteristic analysis. However, significant differences were found (P = .029) in the average vaginal cuff closure time (12.7 ± 3.1 min. for barbed suture group vs. 20.4 ± 7.1 min. for polyglactin 910 group). No dehiscence case was found in any group. Based on the results of this study, we can conclude that unidirectional barbed suture reduces the surgical time for vaginal cuff closure during total laparoscopic hysterectomy and doesn't increase the vaginal cuff dehiscence risk.
Subject(s)
Hysterectomy/instrumentation , Laparoscopy/instrumentation , Polyglactin 910/adverse effects , Surgical Wound Dehiscence/prevention & control , Sutures/adverse effects , Wound Closure Techniques/instrumentation , Absorbable Implants/adverse effects , Adult , Female , Humans , Hysterectomy/adverse effects , Laparoscopy/adverse effects , Longitudinal Studies , Prospective Studies , Surgical Wound Dehiscence/etiology , Suture Techniques/adverse effects , Suture Techniques/instrumentation , Treatment Outcome , Vagina/surgery , Wound Closure Techniques/adverse effectsABSTRACT
OBJECTIVE: To evaluate the effect of normal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and obesity on clinical results among patients who underwent total laparoscopic hysterectomy (TLH). METHODS: In a prospective study at the Civil Hospital of Culiacan in Sinaloa State, Mexico, data were compared from 209 patients who underwent TLH between July 6, 2009, and December 30, 2011. The following primary variables were analyzed for 77 normal BMI patients, 82 overweight patients, and 50 obese patients: procedure duration, operative bleeding, major and minor trans-operative complications, length of hospital stay, and postoperative pain. RESULTS: The mean duration of surgical procedure (P<0.001) and operative bleeding (P=0.002) were lower for patients with normal BMI compared with the other 2 groups. The rate of conversion to laparotomy was similar among the 3 groups. Overall, the frequency of complications was 6.2% (n=13/209); the frequency of complications by study group was 2.6%, 4.8%, and 14% for the normal BMI, overweight and obesity groups, respectively (P<0.05). Major complications were more frequent among patients with obesity (P=0.010). CONCLUSION: The duration of surgical procedure and operative morbidity were found to increase, mainly owing to major complications, among patients with obesity (BMI ≥ 30).
