Abdominal Midline Wound Closure: Small Tissue Bites Versus Large Tissue Bites

The goal of this clinical trial is to learn whether a small stitch technique works better than a large bite technique for closing midline abdominal surgery wounds in adults having midline laparotomy surgery.

The main questions it aims to answer are:

Does the small stitch technique lower the risk of surgical site infection? Does the small stitch technique lower the risk of wound dehiscence (reopening of the wound)? Researchers will compare the small stitch technique with the large bite technique to see if the small stitch technique leads to fewer wound complications after surgery.

Participants will:

Have their abdominal wound closed using either the small stitch or large bite technique during surgery Attend follow-up visits at 2 weeks and 1 month after surgery Be checked for wound complications, including infection and wound reopening In the small stitch technique, stitches are placed 5 millimeters from the wound edge and 5 millimeters apart. In the large bite technique, stitches are placed 10 millimeters apart.

Study Overview

• Status: Completed
• Conditions: Stitch Technique
• Intervention / Treatment: Procedure: Small Stitch Closure Technique; Procedure: Large Stitch Closure Technique

Detailed Description

This clinical trial is designed to evaluate two different methods of closing abdominal wounds after midline laparotomy surgery in adults. A midline laparotomy is a common surgical procedure in which an incision is made along the middle of the abdomen to allow surgeons access to internal organs. Proper closure of this incision is important because complications such as infection or reopening of the wound can lead to pain, delayed recovery, longer hospital stays, and additional treatment.

The study focuses on comparing a "small stitch" technique with the more traditional "large bite" technique used to close the abdominal wall at the end of surgery. Researchers want to determine whether the small stitch method can improve healing and reduce complications after surgery.

In the small stitch technique, sutures are placed approximately 5 millimeters from the edge of the wound and spaced 5 millimeters apart. This approach is designed to distribute tension more evenly across the wound and may help preserve blood supply to the tissues, potentially improving healing. In the large bite technique, stitches are placed farther from the wound edge and farther apart, which is the conventional method commonly used in many surgical settings.

The main goals of the study are to determine:

Whether the small stitch technique reduces the risk of surgical site infections Whether the small stitch technique lowers the chance of wound dehiscence, a serious complication in which the surgical wound partially or completely reopens after surgery Adults undergoing midline laparotomy surgery may be eligible to participate. During the procedure, participants will have their abdominal incision closed using either the small stitch or the large bite technique. The method used will be assigned according to the study protocol so that researchers can fairly compare outcomes between the two groups.

After surgery, participants will continue with routine postoperative care and attend follow-up visits approximately 2 weeks and 1 month after their operation. At these visits, the surgical wound will be examined for signs of infection, delayed healing, wound reopening, pain, or other complications. Researchers will collect and compare the results from both groups to determine which closure method provides better outcomes.

The information gained from this study may help surgeons identify the safest and most effective way to close abdominal incisions, potentially improving recovery and reducing postoperative complications for future patients undergoing abdominal surgery.

• Study Type: Interventional
• Enrollment (Actual): 88
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Karachi, Pakistan, 75510
    • Indus Hospital and Health Network

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

. Age 18-80 years, either sex

• Midline laparotomy (elective or emergency)
• ASA class I-IV

Exclusion Criteria:

• Previous incisional hernia or midline incision
• Contaminated surgery
• ASA V-VI

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Small Stitch Closure Technique; Participants in this arm will undergo abdominal wall closure using the small stitch technique following midline laparotomy surgery.	Procedure: Small Stitch Closure Technique; In this technique, sutures are placed approximately 5 millimeters apart using a continuous suturing method.; Other Names: Small Bite Closure Technique
Active Comparator: Large Stitch Closure Technique; Participants in this arm will undergo abdominal wall closure using the large stitch technique following midline laparotomy surgery	Procedure: Large Stitch Closure Technique; In this technique, sutures are placed approximately 10 millimeters apart using a continuous suturing method.; Other Names: Large Bite Closure Technique

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sheath Dehiscence	Abdominal fascial (sheath) dehiscence, defined as partial or complete separation of the abdominal fascial closure with or without evisceration, assessed by clinical examination of the surgical wound by the treating surgical team. The outcome will be reported as the number of participants who develop fascial dehiscence during the follow-up period.	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Skin dehiscence	Postoperative skin wound dehiscence, defined as partial or complete separation of the skin edges of the surgical incision, assessed by standardized clinical wound examination performed during postoperative follow-up. The outcome will be reported as the number of participants who develop skin wound dehiscence.	30 days
Southampton wound grading	normal healing, erythema, discharge, purulence	30 days

Collaborators and Investigators

• Sponsor: Indus Hospital and Health Network
• Investigators: Study Director: Nazia Lodhi, MBBS, FCPS, Indus Hospital and Health Network

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2025
• Primary Completion (Actual): February 28, 2026
• Study Completion (Actual): March 30, 2026

Study Registration Dates

• First Submitted: May 18, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 2, 2026

Study Record Updates

• Last Update Posted (Actual): June 2, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Abdominal midline wound closure; Short stitch technique; Large stitch technique
• Other Study ID Numbers: IHHN_IRB_2024_03_014

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No