The Overlapping Running Suture Method Using Single Knotless Barbed Absorbable Suture Material for Abdominal Wall Closure after Single Incision Laparoscopic Appendectomy: Comparison with the Traditional Interrupted Closure Technique

Abstract

Purpose: We applicated the V-Loc 90 into abdominal wall closure in single incision laparoscopic appendectomy (SILA) from 2014. The aim of our study is to present our experience of abdominal wall wound closure technique using barbed suture in SILA and comparision of perioperative outcomes with conventional method of layer by layer abdominal wall closure after SILA. Methods: From August 2014 to June 2015, SILA was performed on 160 patients with acute appendicitis at the department of surgery, Hallym sacred heart hospital. Under approval of Insti-tutional Review Board, data concerning demographic characteristics, operative outcomes, postoperative complications were compared between both V-loc closure group and conventional layer by layer closure procedures. In V-loc closure group, after removing the appendix, divided linear alba was closed using unidi-rectional absorbable barbed suture V-Loc 90 2-0 with continous running fashon. Begins at the end of incision, and coming back with reinforced running. Subcutaneous closure was also done using same thread, and the subcuticular suture along incision line was performed with remaning portion of V-Loc. Results: The demographic data of patients's characteristics were similar between the two groups. The use of barbed suture significantly reduced the suturing time for abdominal wall closure (p= 0.014) compared with conventional suture. The postoperative incision length was significantly shorter in V-loc group than conventional group (p=0.034). The rate of surgical site infection were similar in both group. No incisional hernia were noted in both group with median follow up periods of 25.2 months. The total costs of the procedure were comparable in both group under Korean DRG system. Conclusions: The use of barbed suture in abdominal wall closure in single port laparoscopic appendectomy is safe, and feasible method, reduces the suturing time, thereby decreasing the total operation time, and incision length with cosmetic effect.