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Background: An incision inside the umbilicus is popular used in single port surgery intra-umbilical skin incision surgeries have been proven efficient and safe. When compared to infra-umbilical skin incisions, an incision wound was invisible after the operation. Why not use intra-umbilical skin incision in postpartum tubal sterilization.
Objective: To compare aesthetic scores of an incision wound, surgical time and complications in postpartum sterilization under infra-umbilical and intra-umbilical skin incision.
Methods: This was a randomized controlled trial conducted in Prapokkhlo Hospital, Chanthaburi, Thailand. Patients (n = 58) with informed consents were randomly assigned to one of the two skin incision techniques for postpartum sterilization (n = 29 for each arm). Surgical times were recorded. Both the patients and an independent physician made wound aesthetic assessments one week after the operation using the Patient and Observer Scar Assessment Scores (POSAS), which compares the wound to the nearby skin. T tests and exact probability statistical tests were used for statistical analysis.
Results: The surgeon’s POSAS scores in intra-umbilical incisions were significantly closer to normal skin than those in infra-umbilical incisions (6.8 ± 1.5 vs 12.5 ± 5.0; P < .001). A similar finding was observed for patient POSAS scores (6.5 ± 1.2 vs 15.4 ± 5.0; P < .001). The operation times were also shorter (9.1 ± 2.8 vs 11.8 ± 4.7 minutes; P = .009). Neither intra-abdominal injuries nor wound infections were observed.
Conclusions: Postpartum sterilization using intra-umbilical skin incision was more efficient in regard to aesthetic concerns and operation time.
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2. Park SY, Kim KH, Yuk JS, Ji HY, Lee JH. Skin closure methods after single port laparoscopic surgery: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2015;189:8-12.doi:10.1016/j.ejogrb.2015.03.014.
3. Lee JS, Hong TH, Kim JG. A comparison of the periumbilical incision and the intraumbilical incision in laparoscopic appendectomy. J Korean Surg Soc. 2012;83(6):360-366. doi:10.4174/jkss.2012.83.6.360.
4. Phongnarisorn C, Chinthakanan O. Transumbilical single-incision laparoscopic hysterectomy with conventional laparoscopic instruments in patients with symptomatic leiomyoma and/or adenomyosis. Arch Gynecol Obstet. 2011;284(4):893-900. doi:10.1007/s00404-010-1770-0.
5. Arslan S, Korkut E. The intra-umbilical approach in umbilical hernia. Eurasian J Med. 2014;46(1):32-35. doi:10.5152/eajm.2014.06.
6. Angioni S, Pontis A, Sedda F, et al. Single-port versus conventional multiport access prophylactic laparoscopic bilateral salpingo-oophorectomy in high-risk patients for ovarian cancer: a comparison of surgical outcomes. Onco Targets Ther. 2015;8:1575-1580. doi:10.2147/OTT.S82570.
7. Matsui Y, Satoi S, Hirooka S, Kon M. Simple suturing technique for umbilical dimple wound after single-incision laparoscopic surgery. J Am Coll Surg. 2015;221(4):e61-e63. doi:10.1016/j.jamcollsurg.2015.07.006.
8. Song T, Cho J, Kim TJ, et al. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial. J Minim Invasive Gynecol. 2013;20(4):460-467. doi:10.1016/j.jmig.2013.01.010.
9. Draaijers LJ, Tempelman FR, Botman YA, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113(7):1960-1965.
10. Wheeless CR. A rapid inexpensive and effective method of surgical sterilization by laparoscopy. J Reprod Med. 1969;3:65-69.
11. Sepilian V, Ku L, Wong H, Liu CY, Phelps JY. Prevalence of infraumbilical adhesions in women with previous laparoscopy. JSLS. 2007;11:41-44.
12. Tinelli A, Malvasi A, Guido M, et al. Laparoscopy entry in patients with previous abdominal and pelvic surgery. Surg Innov. 2011;18(3):201-205. doi:10.1177/1553350610393989.
13. Parker J, Reid G, Wong F. Microlaparoscopic left upper quadrant entry in patients at high risk of periumbilical adhesions. Aust N Z J Obstet Gynaecol. 1999;39(1):88-92. doi:10.1111/j.1479-828X.1999.tb03452.x.
14. Levrant SG, Bieber EJ, Barnes RB. Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc. 1997;4(3):353-356.
15. Agaba EA, Rainville H, Ikedilo O, Vemulapali P. Incidence of port-site incisional hernia after single-incision laparoscopic surgery. JSLS. 2014;18(2):204-210. doi:10.4293/108680813X13693422518317.
16. Krajinovic K, Koeberlein C, Germer CT, Reibetanz J. The incidence of trocar site hernia after single-port laparoscopic cholecystectomy-A single center analysis and literature review. J Laparoendosc Adv Surg Tech A. 2016l;26(7):536-539. doi:10.1089/lap.2015.0596.
17. Satyapan S, Varakamin S, Suwannus P, Chalapati S, Onthuam Y, Dusitsin N. Postpartum tubal ligation by nurse--midwives in Thailand: a field trial. Stud Fam Plann. 1983;14(4):115-118.
18. Dusitsin N, Chalapati S, Varakamin S, Boonsiri B, Ningsanon P, Gray RH. Post-partum tubal ligation by nurse-midwives and doctors in Thailand. Lancet. 1980;1(8169):638-639.
19. Bucklin BA. Postpartum tubal ligation: timing and other anesthetic considerations. Clin Obstet Gynecol. 2003;46(3):657-666.
20. Bucklin BA, Smith CV. Postpartum tubal ligation: safety, timing, and other implications for anesthesia. Anesth Analg. 1999;89(5):1269-1274.
21. Chirdchim W, Wanichsetakul P, Suwannarurk K, Patumanond J. Intraoperative outcomes of intra-umbilical incision vs infra-umbilical incision in post-partum tubal sterilization: a randomized control trial study. Ramathibodi Medical Journal. 2017;40(3):29-37.