Effect of Continuous vs Interrupted Suturing Techniques on Perineal Pain after Perineorrhaphy

Objectives: To compare perineal pain and satisfaction between interrupted and continuous skin suturing techniques at the time of perineorrhaphy at the time of surgery for prolapse.

Methods: This was a randomized trial at a single institution. Patients with genital hiatus ≥4 cm undergoing prolapse surgery were screened and consented for perineorrhaphy as part of their planned procedure. The participants were randomized 1:1 for either continuous or interrupted perineal skin closure. The primary outcome was patient reported postoperative pain at 2 weeks, including average perineal pain (score 0-10 on a validated Surgical Pain Scale) at rest, with normal activity, with strenuous activity, and worse pain. Perineal pain was also assessed daily for the first two weeks postoperatively and at three months. Postoperative satisfaction was evaluated at 2 weeks and 3 months using satisfaction questionnaire. Baseline and demographics data were analyzed using Student’s t-test for continuous variables and Fisher’s exact or χ2 tests for categorical variables. Our primary outcomes were evaluated with Wilcoxon rank sum, and χ2 tests when appropriate.

Results: We enrolled 100 participants. Perineorrhaphy was not performed in 8 participants and 3 were lost to follow-up resulting in 89 participants with primary outcome data, resulting in 44 in the continuous and 45 in the interrupted group. Demographic characteristics, preoperative exam including genital hiatus measurements, and concomitant pelvic procedures were similar between the two groups. There were no significant differences between the continuous and interrupted groups average perineal pain at rest (0.8 ± 1.2 vs 1.1 ± 1.7, P = 0.74, respectively), during normal activity (1.7 ± 1.9 vs 1.7 ± 2.1, P = 0.81), perineal pain with strenuous activity (1.0 ± 1.4 vs 1.3 ± 3, P =0.76), and worst perineal pain (2.0 ± 2.2 vs 1.9 ± 2.4, P = 0.60) two weeks postoperatively. The number of patients satisfied with overall pain control at 2 weeks was not significantly different between continuous and interrupted suturing groups [36 (81.8 %) vs. 40 (87 %), P =0.50].

Conclusions: Perineal pain and patient satisfaction with perineorrhaphy was not significantly different between continuous and interrupted skin suturing techniques. According to this study, differences in surgeon preference in skin closure technique will not impact perineal pain or patient satisfaction.