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

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, 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

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.

Keywords: Burst abdomen; Human; Randomised-controlled trial; Short stitches; Small bites; Surgical site infection.

Conflict of interest statement

Participating institutions received case payments from Aesculap AG to cover study costs. P.B. reports personal fees from Aesculap AG during the conduct of the study and outside the submitted work. F.K. reports personal fees from BD Bard outside the submitted work. M.W. received funding from the German Research Association (DFG, 401299842). R.F. reports personal fees from Aesculap AG during the conduct of the study as well as personal fees from Aesculap AG and BD BARD outside the submitted work. The remaining authors declare no other conflicts of interest.

© 2021. The Author(s).

Figures

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Fig. 1
CONSORT flow diagram

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