Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial

Deerenberg, Eva B.; Harlaar, Joris Jan; Steyerberg, Ewout W.; Lont, Harold E; Doorn, Helena C. van; Heisterkamp, Joos; Wijnhoven, Bas P. L.; Schouten, W. R.; Cense, Huib A.; Stockmann, H. B. A. C.; Berends, Frits J.; Dijkhuizen, F. P. H. L. J.; Dwarkasing, Roy S.; Jairam, An P.; Ramshorst, Gabriëlle H. van; Kleinrensink, Gert-Jan; Jeekel, J.; Lange, Johan F.

doi:10.1016/s0140-6736(15)60459-7

Cited by 425 publications

(326 citation statements)

References 28 publications

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“…In a meta-analysis on abdominal wall closure including 56 randomized controlled trials (RCTs) with altogether 14 618 patients of an international patient population, the incidence of incisional hernia occurring within 2 years after index surgery was calculated to be 12.8% (95% confidence interval [CI]: [11.4; 14.2]) (2). Since the surgical technique used for abdominal wall closure can significantly influence the incidence of incisional hernia, these data are to be interpreted on a relative basis (3)(4)(5). Endoscopic surgery is associated with a lower incidence of incisional hernia: A meta-analysis of 34 RCTs including 3490 patients showed that incisional hernia is significantly less common after laparoscopic procedures compared to open surgery (4.3 vs. 10.1%; risk difference −0.06; 95% CI [−0.09; −0.03]; p = 0.0002]) (6).…”

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confidence: 99%

The Treatment of Incisional Hernia

Dietz

Menzel

Lock

et al. 2018

Deutsches Ärzteblatt International

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SummaryBackground: A meta-analysis of studies from multiple countries has shown that the incidence of incisional hernia varies from 4% to 10% depending on the type of operation. No epidemiological surveys have been conducted so far. The worst possible complication of an incisional hernia if it is not treated surgically is incarceration. In this article, we present the main surgical methods of treating this condition. We also evaluate the available randomized and controlled trials (RCTs) in which open and laparoscopic techniques were compared and analyze the patients' quality of life.

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confidence: 99%

The Treatment of Incisional Hernia

Dietz

Menzel

Lock

et al. 2018

Deutsches Ärzteblatt International

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“…Although a recent study has proposed a change in the technique of abdominal fascial closure, conventional techniques of closure (mass closure and layered closure) are still more popular. 1 Mass closure is the preferred technique of many surgeons, including those at our centre.…”

Section: Discussionmentioning

confidence: 99%

“…A study was done to compare large bites suture technique with the small bites technique for fascial closure of midline laparotomy incisions and the latter was found effective. 1 Another study showed that continuous closures with nonabsorbable suture was effective to close abdominal wounds. However, if infection or distention is anticipated, interrupted absorbable sutures are preferred.…”

Section: Introductionmentioning

confidence: 99%

Comparison of non-absorbable (polypropylene) versus delayed absorbable (polydioxanone) suture material for abdominal wound closure after laparotomy

Pai

Shenoy

2018

Int Surg J

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INTRODUCTIONThe technique of closure of the abdomen after a surgery has often been a topic of debate. An ideal closure should be easy, provide adequate strength and act as a barrier for the infection. It should be tension free, to avoid ischemia and the closure should be comfortable for the patient.Laparotomy wound related complications are a major source of post-operative morbidity. These include wound infections, incisional hernias and burst abdomen (wound dehiscence). Many factors influence the occurrence of these complications. A study was done to compare large bites suture technique with the small bites technique for fascial closure of midline laparotomy incisions and the ABSTRACT Background: Type of suture material used for fascial closure in laparotomies influences the incidence of postoperative complications. Currently there is no consensus on the superiority of either absorbable or non-absorbable suture materials for abdominal fascial closure. Aim of this study was to determine the superior suture material for abdominal wall closure after elective laparotomy among polypropylene and polydioxanone based on the occurrence of specific post-operative complications. Methods: A prospective observational study was conducted at Kasturba hospital, Manipal from September 2014 to August 2016. Patients admitted under General surgery, who underwent midline laparotomy were included in the study. Polydioxanone and Polypropylene suture materials were used for mass closure and post-operative complications were compared. Results: Hundred patients were included. The two study groups (Prolene and Polydioxanone) were homogenous, with no significant difference between age, BMI, co-morbidities and indication for surgery. Surgical site infection was significantly more in prolene group (p=0.031). Duration of surgeries was longer in prolene group (p=0.020), hence, a subgroup analysis was done and only surgeries under 4-hour duration were analysed. It showed no difference between the two groups with respect to surgical site infection (p=0.320). There was no significant difference between the two groups in burst abdomen and incisional hernia. Conclusions: There was no significant difference between Prolene and Polydioxanone when early and late postoperative complications were compared. Hence, either of the two suture materials can be used for abdominal wound closure in elective midline laparotomies.

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“…The trial protocol and primary endpoint results have been published previously4 7. Patients aged 18 years or more were asked to participate in the trial at the outpatient clinic or in hospital on the day before surgery.…”

Section: Methodsmentioning

confidence: 99%

“…A recent RCT demonstrated that a running suture technique with small tissue bites resulted in a reduced incidence of incisional hernia compared with that after use of a running suture technique with large tissue bites4. In that study, small tissue bites were defined as placement of a suture every 5 mm from the wound edge at 5‐mm intervals, based on preclinical studies5 6 that suggested small bites induced wound healing, collagen type l formation and higher bursting strength.…”

Section: Introductionmentioning

confidence: 99%

Development of incisional herniation after midline laparotomy

Harlaar

Deerenberg

Dwarkasing³

et al. 2017

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BackgroundIncisional herniation is a common complication after abdominal surgery associated with considerable morbidity. The aim of this study was to determine whether incisional hernia is an early complication, in order to understand better the aetiology of incisional hernia formation.MethodsThis study involved the secondary analysis of a subset of patients included in a large RCT comparing small and large tissue bites (5 mm every 5 mm, or 1 cm every 1 cm) in patients scheduled to undergo elective abdominal surgery by midline laparotomy. The distance between the rectus abdominis muscles (RAM distance) was measured by standardized ultrasound imaging 1 month and 1 year after surgery. The relationship between the 1‐year incidence of incisional hernia and the RAM distance at 1 month was investigated.ResultsSome 219 patients were investigated, 113 in the small‐bites and 106 in the large‐bites group. At 1 month after surgery the RAM distance was smaller for small bites than for large bites (mean(s.d.) 1·90(1·18) versus 2·39(1·34) cm respectively; P = 0·005). At 1 year, patients with incisional hernia had a longer RAM distance at 1 month than those with no incisional hernia (mean(s.d.) 2·43(1·48) versus 2·03(1·19) cm respectively; relative risk 1·14, 95 per cent c.i. 1·03 to 1·26, P = 0·015).ConclusionA RAM distance greater than 2 cm at 1 month after midline laparotomy is associated with incisional hernia. Closure with small bites results in a smaller distance between the muscles.

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Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial

Cited by 425 publications

References 28 publications

The Treatment of Incisional Hernia

The Treatment of Incisional Hernia

Comparison of non-absorbable (polypropylene) versus delayed absorbable (polydioxanone) suture material for abdominal wound closure after laparotomy

Development of incisional herniation after midline laparotomy

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