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Interrupted 'Figure-of-X' Versus Continuous Suturing Technique for Abdominal Wall Closure in Colorectal Laparotomies (X-CLOSURE)

21 mai 2026 mis à jour par: Islamabad Medical and Dental College

Interrupted 'Figure-of-X' Versus Continuous Suturing Technique for Abdominal Wall Closure in Colorectal Laparotomies: A Comparative Study on the Incidence of Burst Abdomen

This prospective randomized comparative study aims to evaluate whether interrupted figure-of-X fascial closure reduces the incidence of burst abdomen compared with continuous suturing in patients undergoing open colorectal laparotomy. Burst abdomen is a serious postoperative complication associated with increased morbidity, prolonged hospital stay, and reoperation.

A total of 40 adult patients undergoing elective or emergency colorectal laparotomy will be randomized into two groups: interrupted figure-of-X closure or continuous fascial closure. The primary outcome will be the incidence of burst abdomen within 30 days after surgery. Secondary outcomes will include surgical site infection, seroma, hematoma, and length of hospital stay.

The study is being conducted at the Department of General Surgery, Akbar Niazi Teaching Hospital, Islamabad, Pakistan.

Aperçu de l'étude

Statut

Complété

Les conditions

Intervention / Traitement

Description détaillée

Burst abdomen, also known as abdominal wound dehiscence, is a major postoperative complication following midline laparotomy. It is associated with increased postoperative morbidity, prolonged hospitalization, need for reoperation, and increased mortality. Although several abdominal wall closure techniques are currently practiced, the optimal method for preventing fascial dehiscence remains controversial.

Continuous mass closure is commonly used because of its technical simplicity and shorter operative time. However, interrupted techniques, including interrupted figure-of-X suturing, may distribute tension more evenly across the wound and potentially reduce the risk of fascial disruption. Previous randomized and observational studies have shown inconsistent results regarding superiority of one closure technique over another, particularly in high-risk abdominal surgeries.

This study aims to compare interrupted figure-of-X closure with continuous fascial closure in patients undergoing colorectal laparotomy. The study will be conducted as a prospective, randomized, single-center comparative trial at Akbar Niazi Teaching Hospital, Islamabad, Pakistan.

After informed consent and eligibility assessment, 40 adult patients undergoing elective or emergency open colorectal laparotomy will be randomized in a 1:1 ratio into two groups:

Group A: Interrupted figure-of-X fascial closure Group B: Continuous fascial closure

Randomization will be performed using computer-generated permuted blocks with allocation concealment through sealed opaque envelopes. Surgeons cannot be blinded because of the nature of the intervention; however, postoperative outcome assessors and data analysts will remain blinded to group allocation.

The abdominal fascia in both groups will be closed using slowly absorbable monofilament sutures according to a standardized operative protocol. Operative variables including suture material, bite spacing, operative duration, contamination level, and postoperative wound complications will be recorded.

The primary outcome will be incidence of burst abdomen within 30 days following surgery. Secondary outcomes will include surgical site infection, seroma formation, hematoma, reoperation, and postoperative length of hospital stay.

The findings of this study may help determine a safer and more effective abdominal wall closure technique in colorectal laparotomy patients and may contribute to improved postoperative surgical outcomes in high-risk populations.

Type d'étude

Interventionnel

Inscription (Réel)

40

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • Pakistan
    • Punjab Province
      • Islamabad, Punjab Province, Pakistan, 46000
        • Islamabad Medical and Dental College

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

  • Adulte
  • Adulte plus âgé

Accepte les volontaires sains

Non

La description

Inclusion Criteria:

  • Adult patients (aged 18 years and above).
  • Patients undergoing open laparotomy for histologically confirmed colorectal cancer.
  • Elective surgical procedures.

Exclusion Criteria:

  • Patients with a previous midline laparotomy within the last 30 days.
  • Patients in whom the abdominal wall is planned to be left open or managed with a temporary closure (open abdomen).
  • Patients with known connective tissue disorders (e.g., Ehlers-Danlos syndrome) that might impair wound healing.
  • Patients with an expected survival of less than 30 days.
  • Emergency laparotomies.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: La prévention
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Double

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: interrupted figure of X SUTURE
Abdominal wall closure performed using the interrupted 'Figure-of-X' suturing technique. The fascia is closed with interrupted X-shaped sutures using a slowly absorbable monofilament (PDS) or similar material. Each suture involves taking 1 cm tissue bites from the fascial edges with approximately 1 cm intervals between each 'X' to ensure secure mass closure.
Procédure: Interrupted 'Figure-of-X' Suturing Technique

For the Figure-of-X: Specify the use of a "slowly absorbable monofilament suture" with "1 cm tissue bites and 1 cm spacing" in an interrupted X-pattern.

For the Continuous closure: Specify the use of a "single-layer continuous mass closure" with the same suture material and spacing requirements
Comparateur actif: CONTINUOUS MASS CLOSURE
: Abdominal wall closure performed using the standard continuous (running) suturing technique. A single-layer continuous mass closure is executed using a slowly absorbable monofilament suture material. The technique involves continuous stitching with approximately 1 cm tissue bites and 1 cm intervals between each loop to ensure an even distribution of tension across the midline incision.
Procédure: CONTINUOUS AMSS CLOSURE
The abdominal fascia is closed using a standard single- layer continuous (running) mass closure technique. A slowly absorbable monofilament suture is used to provide prolonged tensile strength. The technique follows a continuous suture line with approximately 1 cm tissue bites from the fascial edges and a 1 cm interval between each loop (travel). The suture is started at one end of the incision and continued to the other, ensuring even tension throughout the length of the midline laparotomy wound.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
THE INCIDENCE OF BURST ABDOMEN
Délai: UPTO 30 DAYS POST SURGERY
The number of participants experiencing postoperative disruption of the musculo-fascial layer (complete wound dehiscence) following midline laparotomy.
UPTO 30 DAYS POST SURGERY

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Incidence of Surgical Site Infection (SSI)
Délai: UPTO 30DAYS POST SURGERY
Occurrence of infection at the surgical site, categorized as superficial, deep, or organ/space infection according to CDC criteria.
UPTO 30DAYS POST SURGERY
Postoperative Seroma and Hematoma Formation
Délai: Up to 30 days post-surgery.
Outcome Measure Description: The occurrence of fluid collection (seroma) or blood collection (hematoma) within the surgical wound.
Up to 30 days post-surgery.
Length of Hospital Stay
Délai: From date of surgery until date of discharge (approximately 7-14 days).
The total number of days the participant remains in the hospital starting from the day of surgery until discharge.
From date of surgery until date of discharge (approximately 7-14 days).

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Islamabad Medical and Dental College

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Liens utiles

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

7 novembre 2025

Achèvement primaire (Réel)

5 avril 2026

Achèvement de l'étude (Réel)

15 mai 2026

Dates d'inscription aux études

Première soumission

7 mai 2026

Première soumission répondant aux critères de contrôle qualité

7 mai 2026

Première publication (Réel)

13 mai 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

26 mai 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

21 mai 2026

Dernière vérification

1 mai 2026

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • CRS-2024-135-8
  • 238/IMDC/IREB-2025 (Autre identifiant: ISLAMABAD MEDICAL AND DENTAL COLLEGE)

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

NON

Description du régime IPD

To protect participant privacy and maintain the confidentiality of sensitive medical information related to colorectal cancer treatment, individual participant data (IPD) will not be made available for public sharing. Data collected for this study will be used strictly for the purposes outlined in the study protocol and will only be accessible to the research team and institutional oversight committees. Aggregate results and study outcomes will be shared through peer-reviewed publications and conference presentations.

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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