Short or long-stitch technique which is better for midline laparotomy?
Germany: After midline laparotomy, incisional hernia remains a frequent problem. A recent study in the British Journal of Surgery found that between short and long stitches, the 1-year incisional hernia development was relatively low with clinical but no statistical differences.
René H Fortelny, Sigmund Freud Privat Universität, Med. Fakultät, Vienna, Austria, and colleagues conducted a prospective, multicentre, parallel-group, double-blind, randomized, controlled superiority trial -- ESTOIH to compare a short stitch to standard loop closure using an ultra-long-term absorbent elastic suture material.
Adult patients were randomly assigned to fascial closure using a short stitch (5 to 8 mm every 5 mm, USP 2-0, single thread HR 26 mm needle) or long stitch technique (10 mm every 10 mm, USP 1, double loop, HR 48 mm needle) with a poly-4-hydroxybutyrate-based suture material (Monomax) by computer-generated sequence. The primary outcome was incisional hernia assessed by ultrasound 1 year after surgery.
Based on the study, the researchers found the following:
- The trial randomized 425 patients to short (n = 215) or long stitch technique (n = 210) of whom 414 (97.4 percent) completed 1 year of follow-up.
- In the short stitch group, the fascia was closed with more stitches (46 (12 s.d.) versus 25 (7 s.d.)) and a higher suture-to-wound length ratio (5.3 (2.2 s.d.) versus 4.0 (1.3 s.d.)).
- At 1 year, seven of 210 (3.3 percent) patients in the short and 13 of 204 (6.4 percent) patients in the long stitch group developed incisional hernia (odds ratio 1.97).
"The need for surgical repair was equal in both groups, despite the greater number of hernias in the long stitch group," the researchers wrote, "which raises the question of whether a reduced number of hernias can translate into a clinical advantage."
"In this regard, the general quality of life, pain, and self-care after 1 year was better for the short stitch group," they conclude.
Reference:
René H Fortelny, Dorian Andrade, Malte Schirren, Petra Baumann, Stefan Riedl, Claudia Reisensohn, Jan Ludolf Kewer, Jessica Hoelderle, Andreas Shamiyeh, Bettina Klugsberger, Theo David Maier, Guido Schumacher, Ferdinand Köckerling, Ursula Pession, Anna Hofmann, Markus Albertsmeier, Effects of the Short Stitch Technique for Midline Abdominal Closure on Incisional Hernia (ESTOIH): Randomized Clinical Trial, British Journal of Surgery, 2022;, znac194, https://doi.org/10.1093/bjs/znac194
