Innovative Suture Technique for Endoscopic Hernia Incision
Condition: Suture Techniques; Medical Glue
Study type: Interventional

Summary: 
      The minimally invasive surgical technique represented by endoscopy is one of the most
      important inventions in the medical field of the 20th century. Laparoscopic surgery is a
      technique in which a rod-shaped camera and special surgical instruments are inserted into the
      body cavity (abdominal cavity, chest cavity, etc.) to complete the surgical operation by
      poking 3-4 holes (0.5-2 cm in size) in the body wall[2]. These holes are known as poke holes,
      and the closure of poke holes is a technique that every young surgeon must master. Currently,
      the proportion of endoscopic minimally invasive surgeries, including inguinal hernia repair,
      has increased widely in China. Currently, most of inguinal hernia repairs at our center are
      performed laparoscopically. Shortening the suture time and healing time of the stuck hole,
      improving the healing strength of the skin, and reducing scar hyperplasia are issues worth
      discussing.

      Barbed sutures were first used in plastic surgery and are now widely used in laparoscopic
      tissue suturing. Because it is knot-free and one-way tightening, the tension of the incision
      can be released evenly, avoiding excessive local tension in the incision and causing ischemia
      and necrosis, which in turn affects the healing of the incision. Barbed thread sutures can be
      used to quickly close the incision and achieve excellent results. A good incision reduces
      tension and prevents scarring. Medical glue can quickly form a thin waterproof film on the
      surface of an incision, which promotes blood coagulation, wound shrinkage, and sealing.

      Inguinal hernia is a common and frequently occurring condition. Minimally invasive surgery
      for an inguinal hernia can reduce postoperative pain, help patients resume daily activities
      early, and achieve rapid recovery; therefore, it is being accepted by an increasing number of
      people[12]. After laparoscopy, the treatment of poking holes is an indispensable part of
      surgery and is directly related to postoperative recovery, aesthetics, and patient
      satisfaction. Combining the continuous tension reduction suture of the dermis barbed suture
      with epidermis glue should help achieve better incision healing, reduce incision scars, and
      simultaneously return to daily activities faster, shower after surgery, and improve the
      medical treatment experience. This is the first study to try this novel approach.

      A total of 100 patients who underwent laparoscopic total extraperitoneal (TEP) inguinal
      hernia repair in the General Surgery Department of Zhongshan Hospital Affiliated with Xiamen
      University from January 2022 to May 2022 were selected as the research subjects. They were
      randomly divided into two groups; the traditional Vicryl interrupted suture was used to poke
      the hole (control group), and the dermis barbed suture was used for continuous tension
      reduction suture combined with the epidermis glue to poke the hole (experimental group).
      Statistical differences were compared between the two stitching methods regarding operation
      time, incision healing, incision healing scars, and incision complications.
    


Intervention name(s): Dermal barb suture combined with medical glue
Intervention type(s): Procedure
Intervention description(s): In the experimental group, after tension reduction and suture were completed, the wound and surrounding skin were wiped clean with normal saline and clean gauze, and the blood accumulated in the wound was squeezed out. Histoacryl medical tissue glue (specification:0.5 ml/piece, main components: n-butyl 2-cyanoacrylate (embutate), pigment (1-hydroxy-4[(toluene)amino]-9,10-anthraquinone), and stabilizers (p-diphenol, sulfur dioxide, phosphoric acid)) were evenly spread on the surgical incision and kept in the butt state for 4 to 6 seconds. After it got solidify and dry, a sterile gauze covered the surgical incision. There was no need to disinfect and change the dressings after the operation. Patients can shower normally on the day after the operation by just avoiding rubbing the incision covered with glue. Patients can move normally 1-2 days after the operation, and the glue film falls off on its own within 5-10 days.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment