Short or long-stitch technique which is better for midline laparotomy?

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-07-16T09:00:38+05:30 | Updated On 16 July 2022 2:39 PM IST

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

British Journal of Surgerymidline laparotomyincisional hernia

Source : British Journal of Surgery

Medha Baranwal

MSc. Biotechnology

Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751