Comparing contact dermatitis due to tissue adhesives in port-site closure

BACKGROUND: (Advanced Medical Solutions; LB) are two commonly used tissue adhesives; however, there are no direct data comparing their risk of contact dermatitis. In this randomized controlled trial, we compare the rate of contact dermatitis associated with DB versus LB in patients undergoing laparoscopic abdominal surgery. METHODS: This was a single-center, intra-patient randomized controlled trial which included patients undergoing elective laparoscopic or robotic abdominal surgery. For each patient, DB was applied to incisions on one side of the abdomen and LB was applied to the contralateral side. The side for each glue was randomized by date of the month. The primary outcome was the proportion of patients experiencing contact dermatitis within 6 weeks postoperative period. RESULTS: One hundred eighty patients were enrolled, and 1 was lost to follow up. Contact dermatitis occurred in 21 of 180 patients (11.7%). DB alone caused reactions in 3 patients (1.7%), LB alone in 1 patient (0.6%), and both adhesives in 17 patients (9.5%). The matched-pairs odds ratio for LB versus DB was 0.33 (95% CI 0.01-4.15, p = 0.63). A sensitivity analysis for patients lost to follow up did not change the results. 7 (33%) patients required treatment for contact dermatitis, all of whom had bilateral reactions. CONCLUSION: Contact dermatitis due to tissue adhesive was seen in 11.7% of patients; however, there was no statistically significant difference between the rates seen with DB and LB. The risks and benefits of tissue adhesive should be carefully considered when choosing to use these products in the closure of surgical incisions, and surgeons need to have a clear management algorithm for dermatitis should it occur. This risk does not seem to be mitigated by manufacturer, so adhesive choice may reasonably be guided by factors such as cost, availability, or institutional preference.