Comparison of Unidirectional and Bidirectional Barbed Suture in Vaginal Cuff Closure during Total Laparoscopic Hysterectomy- A Randomised Controlled Trial QC12-QC15
Department of Obstetrics and Gynaecology, WCH Block, JIPMER, D.Nagar, Pondicherry-605006, India.
Introduction: Laparoscopic hysterectomy is increasingly replacing abdominal hysterectomy in many countries. The advantages of laparoscopic approach include short postoperative recovery time and hospitalisation time. However, vaginal cuff closure during laparoscopic hysterectomy can be challenging, especially for beginners. Barbed sutures have been found to be superior to conventional sutures for vaginal cuff closure during laparoscopic hysterectomy in several studies. However, studies comparing different barbed sutures are lacking.
Aim: To compare vaginal cuff closure time, operative time and complications between unidirectional and bidirectional barbed suture during Total Laparoscopic Hysterectomy (TLH).
Materials and Methods: A randomised, controlled clinical trial was conducted from November 2017 to March 2019, in a Medical College in Puducherry, India that involved 46 women, who underwent TLH for benign pathology. After TLH, vaginal cuff closure method was randomised to unidirectional barbed suture or bidirectional barbed suture. The vaginal cuff closure time, total operative time and complications were recorded. The patients were evaluated postoperatively at 4 weeks after the surgery and by phone interview at 6 months. The comparison between the continuous variables was done with independent Students t-test or Mann-Whitney U Test and categorical variables with Chi-square or fisher-exact test. A p-value of <0.05 was considered as statistically significant.
Results: The mean time taken for vaginal cuff closure by unidirectional barbed suture group was 6.8±1.6 minutes and bidirectional barbed suture was 11.3±1.46 minutes (p<0.001). The mean operative time in the unidirectional barbed suture group was 139±48.3 minutes and in the bidirectional barbed suture group was 150.6±42.7 minutes (p=0.39). The frequency of postoperative complications such as bleeding, infection and cuff dehiscence were not statistically significant between the two groups.
Conclusion: Vaginal cuff closure time using unidirectional barbed suture is significantly less when compared to bidirectional barbed suture during TLH.