A Comparison between Chromic Catgut and Polyglactin 910 or Polyglycolic acid Sutures in Episiotomy Repair; A Review of Literature

Objectives: An episiotomy is an incision made at the perineum during childbirth as the infant’s head is crowning. It makes the vaginal opening larger and assist childbirth by enlarging the diameter of the outlet and vulvae to aid a difficult delivery and prevent rupture of tissues and more extensive vaginal tears. To repair this a surgical cut after delivery, correct technique and appropriate suture material are important according to different absorption, inflammatory response and tissue reactions of the catguts. Traditionally, the episiotomy has been closed with chromic suture but other catguts may be beneficial in terms of postpartum discomfort and healing and results showed that there is controversy which one is the best suture material. The goal of our study was to compare the impacts of different sutures on perineal pain, walking, sitting, lying posture and the resumption of sexual intercourse so polyglactin 910 (Vicryl rapide) or polyglycolic acid sutures were compared with chromic sutures and Long term implications were assessed.Material and Methods: A literature search was performed in WEB of SCIENCE, MEDLINE and PUBMED databases using the keywords chromic catgut , polyglactin 910 catgut , polyglycolic acid catgut and episiotomy repair in order to compare the impacts of chromic and polyglactin 910 (Vicryl rapide) or polyglycolic acid sutures on perineal repair. No restrictions were considered. The references in relevant reviews and published clinical trials were included in the study.Results: The results of most of the studies showed that Episiotomy repair with polyglactin 910 and polyglycolic acid offers significant advantages over the traditional chromic suture. Both of them, have better wound healing and significantly less pain even a study showed that the degree of postpartum perineal pain was approximately half as great. These patients return to daily life activities faster. They also reduce dyspareunia and it is associated with earlier resumption of sexual intercourse. All of these indicates the short term benefits of these materials over chromic catgut especially when the skin close by a continuous locked suture. however There were few studies showed no significant difference according to the pain measurement between three groups of polyglactin 910, polyglycolic acid and chromic catguts And also no difference in the resumption of sexual intercourse at 6 weeks after the delivery. There is a study reports more women with removed suture materials and more resuturing requirements.Conclusion: It seems catgut causes more tissue local inflammatory reaction however it absorbs more rapidly, while polyglycolic causes no too little inflammation but the absorption takes longer in conclusion, chromic catgut was not the ideal suture material for episiotomy repair, which resulted in more pain and delayed wound healing so more future studies are suggested.

کلیدواژه ها:

episiotomy repair ، chromic catgut ، polyglactin 910 ، Vicryl rapide ، polyglycolic acid