Peter Walker, MD, John Hall, MD, Kulvinder Bajwa, MD, Sheilendra Mehta, MD, Todd Wilson, MD, Brad Snyder, MD, Angelyn Rivera, BS, Connie Klein, MS, Shinil Shah, DO, Erik Wilson, MD. University of Texas – Houston
Introduction: Laparoscopic port sites are associated with a significant incidence of long-term hernia formation. In addition, closure with closed loop suture may lead to increased post operative pain thereby limiting patient mobility. The development of novel trocar closure systems could offer a pathway towards quality improvement and warrants investigation. We performed a randomized controlled trial comparing a novel anchor based system (Neoclose®) versus standard suture closure.
Methods: A prospective randomized controlled trial of 70 patients undergoing port site closure following robotic assisted laparoscopic sleeve gastrectomy or gastric bypass was completed (35 with Neoclose® device and 35 with standard laparoscopic suture closure). Each patient had both the camera port and stapling port closed (70 port sites in each group). Primary outcome measures included the incidence of hernia (6 week ultrasound), time for port site closure, and depth of needle penetration. Secondary outcome measures were analog pain scoring at post op day 1, week 1 and week 6.
Results: Physical exam as well as ultrasound evaluation showed no hernias in either group at 6 weeks. When compared to suture closure, the Neoclose® device was associated with shorter closure times (20.2 +/- 1.2 versus 30.0 +/- 2.4 seconds, p < 0.001) and needle depth penetration (3.3 +/- 0.1 versus 5.2 +/- 0.2 cm, p < 0.001). The Neoclose® device was associated with decreased pain at 1 week after the operation (analog pain score 0.3 +/- 0.1 versus 0.9 +/- 0.2, p < 0.01). No difference in pain scoring was observed on post operative day 1 or at week 6.
Conclusions: Trocar site closure with the Neoclose® device is associated with decreased closure times and needle depth penetration. No difference in the incidence of hernias was identified very early after operation. The Neoclose® device led to decreased pain 1 week after trocar closure which is potentially secondary to decreased tension when compared to closure with closed loop suture. Long term hernia data (1 year) is pending with patients scheduled for follow up physical exams and ultrasounds.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86437
Program Number: P502
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster