Sutureless Closure of Port Sites After Laparoscopic Pyloromyotomy Using N-Butyl Cyanoacrylate Glue

Ismael Salas, MD, Ashwin Pimpalwar, MD FRCS Ped Surgery. Division of Pediatric Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas.

Background:
Application of glue to the wound has several benefits. Glue is haemostatic, waterproof, leaves no suture marks, allows examination of the wound possible and allows the infant to have a bath the very next day of surgery. Also no wound care or dressing changes are required.

Purpose:
The aim of this study is to retrospectively review our experience using tissue glue for closure of port sites after laparoscopic pyloromyotomy using N-butyl cyanoacrylate glue.

Method:
Over a period of 1.5 years, 30 infants underwent laparoscopic pyloromyotomy by a single surgeon at our institution. M: F ratio was 18:12. Median age was 39 days (Range 22-77). All infants had pyloric stenosis diagnosed on Ultrasound.
Technique:
Laparoscopic pyloromyotomy was done using a single 3mm one step expandable port through the umbilicus. The grasper and the sheathed banana knife were inserted directly through 2mm incisions without ports. After withdrawal of the umbilical port, the fascia was closed with a single 2 ‘0′ vicryl suture. All three incisions were then irrigated with saline and dried. The incisions were then approximated with glue in all cases without any sutures.
All patients were followed in our clinic 3-4 weeks post surgery. Telephone follow up was obtained after 3 months post surgery in all cases.
Photographic and patient/parent satisfaction documentation was obtained during their office visit and telephone interview in all cases. Local complication including wound dehiscence, infection and persistent leakage from the wound site, pain or allergic reaction to the chemical were all recorded.

Results:
Over a period of 1.5 years, 30 infants underwent laparoscopic pyloromyotomy by a single surgeon at our institution. M: F ratio was 18:12. Median age was 39 days (Range 22-77). All infants had pyloric stenosis diagnosed on Ultrasound.
None had any complications, wound dehiscence or local skin reaction/allergy to cyanoacrylate. Scars healed well in all cases and no scars were visible at follow up. Both the parent and the patient were extremely satisfied with the excellent cosmetic results.

Conclusion:
Sutureless closure of port sites after laparoscopic pylorormyotomy with glue is a safe and effective method for wound closure with excellent cosmetic results, no infections and no local wound complication in infants.