AB119. SOH25_AB_098. Comparison of port site closure methods following minimally invasive surgery: a systematic review and network meta-analysis of randomised clinical trials

Background: For minimally invasive surgery (MIS), there are several port-site closure techniques with method of closure varying based on surgeon’s preference. There is no consensus as to the optimal closure method. This study aims to identify optimal port site postoperative wound closure method following MIS with respect to complication rates and cosmetic outcome.

Methods: Network meta-analysis (NMA) was performed in accordance with PRISMA-NMA guidelines for randomised clinical trials (RCTs) comparing at least two methods of port-site closure.

Results: Nineteen RCTs were identified evaluating eight methods of wound closure in 1,932 patients; namely octylcyanoacrylate glue (OCA) (28.7%, 554 patients), Liquiband glue (LB) (18.2%, 352 patients), Leukosan glue (LS) (4.0%, 77 patients), subcuticular suture (SS) (25.1%, 485 patients), transcutaneous suture (TC) (20.2%, 390 patients), subcutaneous suture (SC) (3.5%, 68 patients), adhesive paper tape (APT) (9.6%, 186 patients), and staples (STP) (3.3%, 63 patients). At NMA, there was no significant difference in wound complication, infection, dehiscence, erythema or pain rate irrespective of closure method. At NMA, wound cosmesis was superior for tissue adhesives at both early [LB: odds ratio (OR) =1.1e−12; 95% confidence interval (CI): 6.61e−40, 0.374] and late postoperative follow-up (LS: OR =9.98e−06; 95% CI: 2.58e−19, 0.632), while TC trended towards a significantly inferior cosmetic outcome by VAS ≥3 months postoperatively [mean difference (MD): −0.71; 95% CI: −1.41, 0.00].

Conclusions: This study validates the use of tissue adhesives with respect to primary closure of port sites following MIS due to enhanced cosmetic outcomes with similar rates of postoperative wound complications observed compared to other conventional methods.

Keywords: Closure; cosmesis; laparoscopy; surgery; wound