Safety and Efficacy of Trocar Port-Site Closure Using a Biological Plug Closure in Laparoscopic Bariatric Surgery: a Prospective Study

Youssef Andraos, Youssef Andraos

Abstract

Purpose: Port-site trocar closure is a challenging procedure in laparoscopic surgeries, especially in morbidly obese patients, and complications (herniation, bleeding, pain, and nerve trapping) have potentially severe consequences. This paper provides an overview of existing techniques of suturing and closure in intra-abdominal laparoscopic surgery, outlines the complications associated with port-site closure, and presents a novel technique designed to address those problems by using a sterile absorbable gelatin sponge with strong hemostatic properties (Cutanplast® Plug).

Materials and methods: In this prospective study, 83 successive obese patients undergoing laparoscopic bariatric surgery (sleeve gastrectomy, sleeve plication, gastric bypass), using a standardized skin incision for trocar insertion, had port-site closure using the Cutanplast plug procedure (n = 42) or conventional suturing techniques (n = 41).

Results: The incidence of early complications was lower in the Cutanplast group; no patients had infections compared with 9.8% of Controls (p = 0.055) and no bleeding, ecchymosis, erythema, or redness occurred. Late complications during 2 years of follow-up were significantly lower in the Cutanplast group (0 vs. 7 hernias, p = 0.005). Most patients in the Cutanplast group required only 1-2 procedures (78.6% vs. 58.5%, p = 0.049), whereas 41.5% of controls required 3 procedures. In total, 82 trocars were used in the Cutanplast group versus 99 in controls. The single-step Cutanplast plug technique reduced operating times compared with two-step suturing techniques.

Conclusion: Closure of port-site trocar incisions using Cutanplast plug is fast, efficient, with potential to reduce operating times and decrease bleeding and herniation from port-site trocars insertion, particularly in obese patients.

Keywords: Bariatric surgery; Cutanplast; Obesity; Port-site closure techniques; Surgical complications.

Conflict of interest statement

The author declares no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Representative selection of laparoscopic instruments and closure techniques
Fig. 2
Fig. 2
The Cutanplast® absorbable gelatin plug
Fig. 3
Fig. 3
Trocar port-site closure using an instrument designed for use with the Cutanplast plug. a Loaded trocar position through the abdominal wall and b final view of the Cutanplast plug in position
Fig. 4
Fig. 4
Weight loss index (%) by study group in patients of the full analysis set (FAS) attending weight loss follow-ups (N = 64). One patient (subject #24) in the Control group with a weight loss index of 190% was considered an outlier
Fig. 5
Fig. 5
A port-site trocar complication (seroma) closed by a Cutanplast plug

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