CERVICAL CERCLAGE: SILK Vs NYLON SUTURE.

Introduction:The term ‘cervical incompetence’ is used to describe a disorder in which painless cervical dilatation led to recurrent second trimester pregnancy losses.Structural weakness of cervical tissue was thought to cause or contribute to these adverse outcomes.Cervical cerclageis used for the treatment of cervical incompetence. The relatively muscular and elastic internal Os is responsible for retaining the pregnancy in utero and a cerclage represents an attempt to physically support a weakened cervix. Though various studies have proven the efficacy of cerclage procedure, a number of questions still exist. What is the effect of the type of suture on the cervix? Is there any difference in the outcome following cervical cerclage with a multifilament suture, compared to a monofilament suture? The present study was thus conducted with the objective of comparing difference in cervical cerclage by silk and nylon as a suture material in terms of operability and outcome. The intention is to know the difference between monofilament and multifilament suture. Materials & Methods:A Randomized control study was conducted in the Department of Obstetrics and Gynecology of a Tertiary Care Hospital and Medical college. After fulfilling the inclusion and exclusion criteria, total 50 cases of cervical length less than 3cms were selected and divided into two groups randomly using table of random numbers: Nylon Group: McDonald cerclage procedure using nylon sutures (25 patients) and; Silk group:McDonald cerclage procedure using silk sutures (25 patients). The patients were compared with respect to time taken for procedure, intra-op complications, ease of operability and ease of stitch removal. All the patients were followed up till delivery as per routine ANC schedule and development of fibrosis and outcome were compared. Data was analyzed using SPSS software ver. 21. Results: The mean age and weeks of gestation in nylon group was 23.80±2.71 years and 20.66 weeks whereas in the silk group was 23.24±3.19 years and 21.41 weeks (p-0.507, 0.051). The mean time taken for the procedure in nylon group was 21.20±5.26 min whereas the mean time taken in silk group was 17.20±4.35min (p<0.01). No difference was observed between the study groups with respect to difficulty in operability and ease of suture removal (p>0.05). Intra operative bleeding was significant in 24% women from nylon group and in 12% women in silk group (p-0.46) while Discharge and leakage was reported by 20% of cases each in nylon group and 12% and 20% cases in silk group (p-0.78). No difference was observed between the study groups with respect to development of fibrosis and outcome i.e. type of delivery (p>0.05). Conclusion: The average time taken for the procedure was lesser with silk sutures while significant fibrosis was associated with nylon sutures. Both the suture materials were comparable in terms of operability, complication rate and ease of removal and outcome.