Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial.

Abstract

PURPOSE:

The short-stitch technique for midline laparotomy closure has been shown to reduce hernia rates, but long stitches remain the standard of care and the effect of the short-stitch technique on short-term results is not well known. The aim of this study was to compare the two techniques, using an ultra-long-term absorbable elastic suture material.

METHODS:

Following elective midline laparotomy, 425 patients in 9 centres were randomised to receive wound closure using the short-stitch (USP 2-0 single thread, n = 215) or long-stitch (USP 1 double loop, n = 210) technique with a poly-4-hydroxybutyrate-based suture material (Monomax®). Here, we report short-term surgical outcomes.

RESULTS:

At 30 (+10) days postoperatively, 3 (1.40%) of 215 patients in the short-stitch group and 10 (4.76%) of 210 patients in the long-stitch group had developed burst abdomen [OR 0.2830 (0.0768-1.0433), p = 0.0513]. Ruptured suture, seroma and hematoma and other wound healing disorders occurred in small numbers without differences between groups. In a planned Cox proportional hazard model for burst abdomen, the short-stitch group had a significantly lower risk [HR 0.1783 (0.0379-0.6617), p = 0.0115].

CONCLUSIONS:

Although this trial revealed no significant difference in short-term results between the short-stitch and long-stitch techniques for closure of midline laparotomy, a trend towards a lower rate of burst abdomen in the short-stitch group suggests a possible advantage of the short-stitch technique.

TRIAL REGISTRY:

NCT01965249, registered October 18, 2013.

• Authors: M Albertsmeier, A Hofmann, P Baumann, S Riedl, C Reisensohn, J L Kewer, J Hoelderle, A Shamiyeh, B Klugsberger, T D Maier, G Schumacher, F Köckerling, U Pession, M Weniger, R H Fortelny
• Journal: Hernia : the journal of hernias and abdominal wall surgery (Hernia) Vol. 26 Issue 1 Pg. 87-95 (02 2022) ISSN: 1248-9204 [Electronic] France
• PMID: 34050419 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2021. The Author(s).

Topics

• Abdomen
• Abdominal Wound Closure Techniques (adverse effects)
• Herniorrhaphy
• Humans
• Laparotomy (adverse effects, methods)
• Suture Techniques
• Sutures