Objectives of study :
SSP and SSI have been attributed to tying of sutures & trauma due to suture passer. Aim of this study was to evaluate the benefit of passing transfixating sutures with the help of disposable thin Spinal Needles versus reusable Suture Passes which is much thicker & gets blunted with repeatd use.
Methods and procedures :
25 consecutive uncomplicated ventral hernias included for LVHR done using fascial closure of defect (as earlier reported by us) & transfixation of generously overlapping dual mesh (ePTFE). A uniform perioperative protocol was followed. 4 corners of the mesh analogous to 10-2-4-8 O’ clock positions were randomized for transfixation by either suture passer (SPT) or spinal needle technique (SNT). Rest of mesh margin was transfixed with SNT. 2-0 monofilament nylon suture was used. Follow up records at 3 days (D3), 1 week (W1), 3 weeks (W3) & 3 months (M3) were kept for SSP (visual analog scale) and SSI (tenderness, erythema, induration, discharge, nodule formation) following the same clock-face analogy. Patients were blind to suture technique randomization. Procedure was same but for transfixation, hence SSP and SSI were the end points. Paracetamol was routine analgesic & NSAID was used on demand only after paraetamol failed to give relief.
Results :(As shown in the table)
100 mesh corners were randomized into SPT(n=50) & SNT(n=50) groups.
Analgesic requirement in suture passer group was much higher & in five cases an abdominal binder was required.
Use of thinner, sharper, atraumatic, disposable Spinal Needles for transfixation in LVHR offers significant advantage as compared to thick reusable, relatively lunt Suture Passer both in terms of pain and inflammation.
Program Number: P343