A One Year Randomised Controlled Trial to Compare the Efficacy of Knotless Barbed Sutures vs. Subcuticular Monofilament Sutures for Skin Closure in Open Inguinal Hernia Repair

Abstract

There exists a need to provide good wound closure in terms of low rates of SSI and acceptable cosmesis. The advent of the knotless barbed sutures has provided a novel approach to the same. This study was undertaken to evaluate the efficacy of knotless barbed sutures as compared to the subcuticular monofilament in reducing post-operative pain and SSI in patients undergoing open inguinal hernia repair. Methodology The present randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. A total of 60 patients undergoing elective inguinal hernia repair from January 2017 to December 2017 were divided into two groups of 30 each that is, Group A (wound closure using V-LocTM 90, Knotless barbed sutures) and Group B (wound closure using conventional Monocryl, subcuticular monofilament sutures). Results In this study all participants were males (100%). In Group A, the median age was 56 years (IQR 38, 70) and it was 46 years (IQR 31.75 to 65) in Group B. Median pain scores at 6 hrs were 4 (IQR 4, 5) and 5 (IQR 5, 6) in Group A and B ( P value <0.001) , 12 hrs were 3 (IQR 3, 4) and it was 4 (IQR 4, 5) in Group A and Group B respectively (P Value< 0.001) at 24 hrs it was 4 (IQR 3, 4) and 5 (IQR 4, 5) in Groups A and B respectively (P value <0.001). The median pain score at 48 hrs, was 3 (IQR 3, 4) and 4 (IQR 3, 4) in Groups A and B respectively (P value 0.086) and at 72 hrs was 3 (IQR 2, 3) in Group A and it was 3 (IQR 2.75, 3) in Group B (P value of 0.147). On post-operative Day 3, SSI of grades of Ia and Ic was seen in 3.33% of patients in each group. (P value 1.000) On Day 8, Grade Ia, Ib, Ic and IIa was seen in 3.33% of patients each in Group A and was seen in 3.33% of patients each with Grade Ia, Ib and IIa healing and 6.67% with Grade Ic healing in Group B (P value 0.986) and on Day 10, Group A had 6.67% of patients with Grade Ia, 3.33% with Ib and 3.33% with Grade Ic. Group B had 10% of patients with Grade Ia, 6.67% of patients with Ib and Ic healing each P value (0.789) Conclusion The incidence of SSI with the Knotless barbed sutures (V-LocTM 90) is comparable to the conventional monofilament subcuticular sutures (Monocryl). There was lesser early post-operative pain in the Knotless barbed suture group reported.