Article

Randomized Clinical Trial Comparing Blunt Tapered and Standard Needles in Closing Abdominal Fascia

World Journal of Surgery (impact factor: 2.36). 01/2005; 29(4):441-445. DOI:10.1007/s00268-004-7586-y pp.441-445

ABSTRACT Glove perforation frequently occurs during the course of surgical procedures, introducing risks for both surgeons and patients. The aim of this study was to compare the use of blunt tapered and “sharp” needles during abdominal wall closure with respect to the incidence of glove perforation and the convenience of needle handling. A series of 200 patients undergoing laparotomy in a 6-month period for general surgical disorders were randomized to two groups; in one, the abdominal fascia was closed with a blunt tapered needle; in the other, a sharp needle was used. The main outcome measures were glove perforation and convenience of handling the needle. Univariate and multivariate analyses were performed. In all, 56 glove perforations occurred during 40 (20%) surgical procedures.Perforation rates differed significantly: 12% for the blunt (n = 100) tapered needle and 28% (n = 100) for the sharp needle (p = 0.003). Only in 12 cases (21%) was the glove perforation detected at surgery. The type of needle (odds ratio 0.35, p = 0.006) and time taken to close the fascia (odds ratio 1.001, p = 0.05) significantly affected the risk of glove perforation. At multivariate logistic regression analysis the type of needle (odds ratio 0.23, p = 0.004) and the visual analog linear scale (VAS) for ease of needle handling (odds ratio 1.18, p = 0.019) were important predictive factors for glove perforation. With the blunt tapered needle, the VAS was significantly (p = 0.0003) higher at primary laparotomy than at relaparotomy. Use of the blunt tapered needle reduces the incidence of glove perforation. Laborious closure predicts glove perforation. Blunt tapered needles are less convenient in closing a scarred abdominal fascia.

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Keywords

200 patients undergoing laparotomy
 
56 glove perforations
 
6-month period
 
abdominal fascia
 
abdominal wall closure
 
blunt tapered needle
 
Blunt tapered needles
 
Glove perforation
 
Laborious closure
 
multivariate analyses
 
multivariate logistic regression analysis
 
needle handling
 
primary laparotomy
 
relaparotomy
 
risks
 
scarred abdominal fascia
 
sharp needle
 
surgical procedures
 
visual analog linear scale
 
“sharp” needles
 

Rob A G Nordkam