# A Comparative Study of Triclosan-Coated Suture Versus Conventional Suture on Surgical Site Infections of Abdominal Fascial Closures in Open Appendectomy

## TL;DR

Triclosan-coated sutures significantly reduce surgical site infections and hospital stays after open appendectomy compared to conventional sutures.

## Contribution

This study provides empirical evidence that triclosan-coated sutures reduce SSIs and hospitalization duration in open appendectomy.

## Key findings

- Triclosan-coated sutures reduced SSI incidence from 19.3% to 1.8% compared to conventional sutures.
- Deep SSIs occurred only in the conventional suture group (8.8%) and not in the triclosan-coated group.
- Hospital stay was significantly shorter with triclosan-coated sutures (3.58 days vs. 5.51 days).

## Abstract

Background

Surgical site infections (SSIs) remain a significant challenge following appendectomy procedures, contributing to increased morbidity, prolonged hospitalization, and substantial healthcare costs. This study aimed to compare the efficacy of triclosan-coated polydioxanone sutures (PDS Plus Antibacterial (polydioxanone) Suture; Ethicon Inc., Raritan, New Jersey, United States) with conventional polydioxanone sutures (PDS II (polydioxanone) Suture; Ethicon Inc.) in preventing SSIs following abdominal fascial closure in open appendectomy.

Methods

This prospective comparative study was conducted at a tertiary care hospital in India between March 2023 and January 2025. A total of 114 patients undergoing open appendectomy were equally allocated to receive either conventional PDS II suture (n=57) or triclosan-coated PDS Plus suture (n=57) for abdominal fascial closure. The primary outcome was the incidence of SSI, with secondary outcomes including type of SSI, microbiological profile, hospital stay duration, and associated factors.

Results

Demographics and clinical characteristics were comparable between groups. SSI occurred in significantly fewer patients in the PDS Plus group compared to the PDS II group (1.8% vs. 19.3%, p=0.002). Deep SSIs were observed exclusively in the PDS II group (8.8%), with none in the PDS Plus group (p=0.008). Wound cultures revealed fewer pathogenic bacteria isolates in the PDS Plus group (p=0.04). The mean length of hospital stay was significantly shorter with triclosan-coated sutures (3.58±1.17 vs. 5.51±1.6 days, p<0.001). Patients who developed SSI, regardless of suture type, had significantly longer hospitalizations (7.75±1.7 vs. 4.17±1.2 days, p<0.001). No significant associations were found between comorbidities or diagnostic categories and SSI occurrence.

Conclusion

Triclosan-coated polydioxanone sutures significantly reduce SSI rates and hospital stay duration in open appendectomy procedures. The complete absence of deep SSIs and substantially fewer pathogenic bacteria isolates in the triclosan-coated suture group suggests a potent protective effect against serious infections. These benefits likely offset the higher unit cost of antimicrobial sutures, supporting their use in open appendectomy and potentially other procedures with substantial infection risk.