Synthetic suture materials have several advantages in perineal repair, including less inflammatory response, reduced discomfort, and lack of exposure to animal-derived products. Conversely, their longer degradation periods could lead to prolonged discomfort from foreign material that could also provide a nidus for infection. New synthetic materials claim to be absorbed rapidly and thus to minimize these disadvantages. Greenberg and colleagues compared the performance of a fast-absorbing polyglactin with that of a chromic catgut suture in a randomized trial.
They studied mothers admitted to a teaching hospital for trial of labor. Women who consented to participate in the study were assigned randomly before labor to chromic catgut or fast-absorbing synthetic suture. If perineal sutures were required, the patient was treated using the assigned suture (unless the attending physician believed an alternative suture was indicated). Data were collected on the details of the deliveries, and the participating mothers were interviewed 24 to 48 hours after delivery about pain and other symptoms. Mothers were interviewed again 10 to 14 days and six to eight weeks after delivery.
The 459 mothers who received fast-absorbing polyglactin were similar in all important respects to the 449 mothers treated with chromic catgut. At the initial assessment (after 24 to 48 hours), uterine pain was significantly less common in mothers assigned to the synthetic suture, but no difference was noted between the groups in analgesic use. At 10 to 14 days, the groups did not differ in reported pain. By the six- to eight-week follow-up examination, uterine cramping pain was uncommon overall but significantly less prevalent in mothers assigned to treatment with fast-absorbing polyglactin (1 percent compared with 4 percent). Analgesic use was significantly lower in mothers treated with synthetic suture (5 percent compared with 10 percent).
The groups did not differ in wound breakdown or signs of residual suture material. None of the physicians who initially preferred the fast-absorbing synthetic suture changed his or her preference at the end of the study; however, one half of the 41 physicians who initially preferred another suture switched to polyglactin after the study.
The authors conclude that fast-absorbing polyglactin provides comparable or improved patient comfort and is rarely associated with late complications in perineal repair.